Provider Demographics
NPI:1811216310
Name:THIND, AMANDEEP KAUR
Entity type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:KAUR
Last Name:THIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 TAVISTOCK CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7114
Mailing Address - Country:US
Mailing Address - Phone:313-412-3724
Mailing Address - Fax:
Practice Address - Street 1:11554 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2644
Practice Address - Country:US
Practice Address - Phone:586-558-0185
Practice Address - Fax:586-558-7128
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist