Provider Demographics
NPI:1548510977
Name:WESTBORN PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WESTBORN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NADDEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-277-4529
Mailing Address - Street 1:22644 MICHIGAN AVE.
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-277-4529
Mailing Address - Fax:
Practice Address - Street 1:22644 MICHIGAN AVE.
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-277-4529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health