Provider Demographics
NPI:1205117462
Name:TAHIR, HAFIZ SAFEERHUSSAIN (RPT)
Entity type:Individual
Prefix:
First Name:HAFIZ
Middle Name:SAFEERHUSSAIN
Last Name:TAHIR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19168 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193-8802
Mailing Address - Country:US
Mailing Address - Phone:313-377-9997
Mailing Address - Fax:248-809-3725
Practice Address - Street 1:19168 RED OAK LN
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48193-8802
Practice Address - Country:US
Practice Address - Phone:313-377-9997
Practice Address - Fax:248-809-3725
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501006100OtherLICENSE