Healthcare Provider Details

I. General information

NPI: 1770324402
Provider Name (Legal Business Name): FIMPLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16131 WICK RD
ALLEN PARK MI
48101
US

IV. Provider business mailing address

4808 KORTE ST
DEARBORN MI
48126-4105
US

V. Phone/Fax

Practice location:
  • Phone: 313-485-5426
  • Fax:
Mailing address:
  • Phone: 313-485-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAWAD NAZAR TAJALDEEN
Title or Position: CEO
Credential: DPT
Phone: 313-485-5426