Provider Demographics
NPI:1700551488
Name:BEYDOUN, RABEAH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RABEAH
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17102 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3102
Mailing Address - Country:US
Mailing Address - Phone:734-367-4207
Mailing Address - Fax:
Practice Address - Street 1:17102 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3102
Practice Address - Country:US
Practice Address - Phone:734-367-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-12-09
Deactivation Date:2021-11-22
Deactivation Code:
Reactivation Date:2021-12-08
Provider Licenses
StateLicense IDTaxonomies
MI5501019995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist