Provider Demographics
NPI:1720525223
Name:HANJRA, OMAR TARIQ
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:TARIQ
Last Name:HANJRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 147A ST
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:BC
Mailing Address - Zip Code:V3S4P9
Mailing Address - Country:CA
Mailing Address - Phone:604-704-4811
Mailing Address - Fax:
Practice Address - Street 1:855 AARON DR
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9396
Practice Address - Country:US
Practice Address - Phone:360-354-4434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60688398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist