Healthcare Provider Details

I. General information

NPI: 1750736427
Provider Name (Legal Business Name): ZAHIR MENLA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 06/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 E 12 MILE RD
MADISON HEIGHTS MI
48071-2651
US

IV. Provider business mailing address

790 REMINGTON
BOLINGBROOK IL
60440
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-4886
  • Fax: 248-543-0479
Mailing address:
  • Phone: 630-296-2222
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011991A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: