MEDICARE: GAMBRA RASUL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501009119	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821211954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAMBRA RASUL

Provider Business Mailing Address
First Line	:	2214 KNOTTY PINE TRL
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-7801
Country	:	US
Telephone Number	:	248-250-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	2214 KNOTTY PINE TRL
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-7801
Country	:	US
Telephone Number	:	248-250-1237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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Directions to “ GAMBRA RASUL ” Practice Location

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