Healthcare Provider Details

I. General information

NPI: 1407567563
Provider Name (Legal Business Name): ISHRAT SHARIF PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6149 N WAYNE RD
WESTLAND MI
48185-7128
US

IV. Provider business mailing address

23832 BROWNSTOWN SQUARE DR APT 103
ROMULUS MI
48174-9351
US

V. Phone/Fax

Practice location:
  • Phone: 734-895-3611
  • Fax: 734-331-9608
Mailing address:
  • Phone: 313-627-3229
  • Fax: 734-331-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: