Provider Demographics
NPI:1861757957
Name:MOHAMMED, NISAR AHMED (PT)
Entity type:Individual
Prefix:MR
First Name:NISAR
Middle Name:AHMED
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:30551 STEPHENSON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1645
Mailing Address - Country:US
Mailing Address - Phone:248-677-0216
Mailing Address - Fax:248-677-0228
Practice Address - Street 1:30551 STEPHENSON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1645
Practice Address - Country:US
Practice Address - Phone:248-677-0216
Practice Address - Fax:248-677-0228
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501015977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist