Healthcare Provider Details

I. General information

NPI: 1215842372
Provider Name (Legal Business Name): THANVIR MOHAMAAD MIAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10912 WAYNE RD
ROMULUS MI
48174-1471
US

IV. Provider business mailing address

2538 DONNA AVE
WARREN MI
48091-3946
US

V. Phone/Fax

Practice location:
  • Phone: 734-955-7000
  • Fax:
Mailing address:
  • Phone: 248-525-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: