Provider Demographics
NPI:1487954806
Name:JAMALI, MOHAMMAD M (PT)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:M
Last Name:JAMALI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:45913 WINDRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6224
Mailing Address - Country:US
Mailing Address - Phone:734-495-0686
Mailing Address - Fax:734-495-0688
Practice Address - Street 1:21700 GREENFIELD RD
Practice Address - Street 2:SUIT 257
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2581
Practice Address - Country:US
Practice Address - Phone:734-578-2951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist