Provider Demographics
NPI:1013341106
Name:BANO, AKHTER (RPT/DPT)
Entity Type:Individual
Prefix:
First Name:AKHTER
Middle Name:
Last Name:BANO
Suffix:
Gender:F
Credentials:RPT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25321 5 MILE RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3700
Mailing Address - Country:US
Mailing Address - Phone:313-387-5119
Mailing Address - Fax:
Practice Address - Street 1:25321 5 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3700
Practice Address - Country:US
Practice Address - Phone:313-387-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008541261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy