Provider Demographics
NPI:1548918659
Name:SHAOUNI, MARTIN JOHN (DPT)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOHN
Last Name:SHAOUNI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 SHADY DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1824
Mailing Address - Country:US
Mailing Address - Phone:586-722-8197
Mailing Address - Fax:
Practice Address - Street 1:141 HAMPTON CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4103
Practice Address - Country:US
Practice Address - Phone:248-853-7555
Practice Address - Fax:248-853-7556
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501301953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist