Healthcare Provider Details

I. General information

NPI: 1548918659
Provider Name (Legal Business Name): MARTIN JOHN SHAOUNI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HAMPTON CIR
ROCHESTER HILLS MI
48307-4103
US

IV. Provider business mailing address

1947 SHADY DR
WARREN MI
48092-1824
US

V. Phone/Fax

Practice location:
  • Phone: 248-853-7555
  • Fax: 248-853-7556
Mailing address:
  • Phone: 586-722-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501301953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: