Provider Demographics
NPI:1124816566
Name:AKHTAR, FAVAD
Entity type:Individual
Prefix:
First Name:FAVAD
Middle Name:
Last Name:AKHTAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-4838
Mailing Address - Country:US
Mailing Address - Phone:609-334-4603
Mailing Address - Fax:
Practice Address - Street 1:25 COMMUNICATION WAY
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-8137
Practice Address - Country:US
Practice Address - Phone:800-631-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000025355225100000X
NJ40QA01971200261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist