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NPI Code Detail

MEDICARE: TASNEEM MADAN PT

MEDICARE: TASNEEM MADAN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT016750GA

General Provider Information

NPI Number : 1689450397
Entity Type Code : Individual
Provider Name (Legal Business Name) : TASNEEM MADAN PT
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number :
Provider Business Practice Location Address
First Line : 2103 PLEASANT HILL RD
Second Line :
City : DULUTH
State : GA
Zip : 30096-4629
Country : US
Telephone Number : 470-740-3900
Fax Number : 470-740-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2023
Last Update Date : 09/07/2023

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Directions to “ TASNEEM MADAN PT” Practice Location

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