Provider Demographics
NPI:1811485477
Name:KHALILI, MINU (PT)
Entity type:Individual
Prefix:MRS
First Name:MINU
Middle Name:
Last Name:KHALILI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MINU
Other - Middle Name:
Other - Last Name:KHALILI-PANAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:30795 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5720
Mailing Address - Country:US
Mailing Address - Phone:586-421-3030
Mailing Address - Fax:
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5720
Practice Address - Country:US
Practice Address - Phone:586-421-3030
Practice Address - Fax:586-421-3031
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010711261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy