Healthcare Provider Details

I. General information

NPI: 1598340036
Provider Name (Legal Business Name): LARA DABAJEH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25210 FORD RD
DEARBORN HEIGHTS MI
48127-4818
US

IV. Provider business mailing address

6354 ORCHARD AVE
DEARBORN MI
48126-2070
US

V. Phone/Fax

Practice location:
  • Phone: 313-769-5354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: