Provider Demographics
NPI:1356382303
Name:TOOTLA, NASHEREEN (PT)
Entity type:Individual
Prefix:
First Name:NASHEREEN
Middle Name:
Last Name:TOOTLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30020 SCHOENHERR RD
Mailing Address - Street 2:STE C
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-459-1614
Mailing Address - Fax:586-775-2331
Practice Address - Street 1:10066 DIX RD
Practice Address - Street 2:
Practice Address - City:DEABORN
Practice Address - State:MI
Practice Address - Zip Code:48120
Practice Address - Country:US
Practice Address - Phone:313-554-2536
Practice Address - Fax:313-554-2923
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501010111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist