Provider Demographics
NPI:1063607745
Name:ABULABAN, AHMAD TAHA (PT)
Entity type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:TAHA
Last Name:ABULABAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-6800
Mailing Address - Country:US
Mailing Address - Phone:313-729-8554
Mailing Address - Fax:
Practice Address - Street 1:329 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1543
Practice Address - Country:US
Practice Address - Phone:810-794-8040
Practice Address - Fax:810-794-8041
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist