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General NPI Number Information
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NPI Number | 1255590865
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Entity Type | Individual
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Provider Name | QURATULANN MOGHUL PLEMONS PT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 2590 ELIZABETH LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-3314
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Country | US
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Telephone | 248-681-0854
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Fax |
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Provider Business Mailing Address
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Address Line | 33341 DEQUINDRE RD
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City | TROY
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State | MI
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Zip | 48083-4630
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Country | US
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Telephone | 248-862-2458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005099
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License Number State | MI
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