Provider Demographics
NPI:1003110958
Name:ABBASI, ELIZA (DPT)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:ABBASI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:FATIMA
Other - Last Name:HUSSAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:5210 HIGHLAND RD
Practice Address - Street 2:STE. 100
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1970
Practice Address - Country:US
Practice Address - Phone:248-674-9560
Practice Address - Fax:248-674-9562
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015323OtherPHYSICAL THERAPY LICENSE NUMBER