Healthcare Provider Details

I. General information

NPI: 1467887638
Provider Name (Legal Business Name): NAZISH JAVED DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WEST 21ST AVENUE STE. B
COVINGTON LA
70433
US

IV. Provider business mailing address

270 ABNER JACKSON PKWY
LAKE JACKSON TX
77566-5124
US

V. Phone/Fax

Practice location:
  • Phone: 504-912-3501
  • Fax:
Mailing address:
  • Phone: 979-316-5100
  • Fax: 979-316-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08610R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: