Provider Demographics
NPI:1912312877
Name:FAROOQUI, ATIF AHMED (LPTA)
Entity Type:Individual
Prefix:
First Name:ATIF
Middle Name:AHMED
Last Name:FAROOQUI
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 MICHELSON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5345
Mailing Address - Country:US
Mailing Address - Phone:248-790-0535
Mailing Address - Fax:
Practice Address - Street 1:836 MICHELSON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5345
Practice Address - Country:US
Practice Address - Phone:248-790-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004184225200000X
NY009011-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant