Healthcare Provider Details

I. General information

NPI: 1972410298
Provider Name (Legal Business Name): TAZIMUL HUQ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 ROSCOE BLVD STE A1
VAN NUYS CA
91406-1246
US

IV. Provider business mailing address

5250 HARMONY AVE APT 113
NORTH HOLLYWOOD CA
91601-3256
US

V. Phone/Fax

Practice location:
  • Phone: 818-893-4426
  • Fax:
Mailing address:
  • Phone: 818-309-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: