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General NPI Number Information
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NPI Number | 1417432204
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Entity Type | Individual
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Provider Name | RAYMOND LEE FAIR
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Gender | Male
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 16151 JAMES COUZENS FWY
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City | DETROIT
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State | MI
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Zip | 48221-2821
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Country | US
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Telephone | 313-587-4979
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Fax |
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Provider Business Mailing Address
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Address Line | 22475 SHEVINGTON DR
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City | SOUTHFIELD
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State | MI
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Zip | 48034-2128
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Country | US
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Telephone | 313-575-6859
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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 |
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License Number State |
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