Provider Demographics
NPI:1265758932
Name:SHAKOOR, SALEEM (PT)
Entity type:Individual
Prefix:
First Name:SALEEM
Middle Name:
Last Name:SHAKOOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 ROBERT T LONGWAY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2190
Mailing Address - Country:US
Mailing Address - Phone:810-235-2004
Mailing Address - Fax:810-235-2841
Practice Address - Street 1:2444 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5098
Practice Address - Country:US
Practice Address - Phone:810-695-9270
Practice Address - Fax:810-695-9276
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005572208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation