Healthcare Provider Details

I. General information

NPI: 1912498395
Provider Name (Legal Business Name): JAVID M KHAN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15750 JOY RD
DETROIT MI
48228
US

IV. Provider business mailing address

15750 JOY RD
DETROIT MI
48228-2196
US

V. Phone/Fax

Practice location:
  • Phone: 313-273-6850
  • Fax:
Mailing address:
  • Phone: 734-934-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012916
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: