Healthcare Provider Details

I. General information

NPI: 1902739733
Provider Name (Legal Business Name): AMANDA CHEHAB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PINE GROVE AVE STE 7
FORT GRATIOT MI
48059-4245
US

IV. Provider business mailing address

37704 BAYLOR DR
STERLING HTS MI
48310-4039
US

V. Phone/Fax

Practice location:
  • Phone: 810-824-3763
  • Fax:
Mailing address:
  • Phone: 586-467-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: