Provider Demographics
NPI:1194063339
Name:MOHIBI, MUNIFA (LPT)
Entity type:Individual
Prefix:
First Name:MUNIFA
Middle Name:
Last Name:MOHIBI
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:MUNIFA
Other - Middle Name:
Other - Last Name:ATTARWALATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2575 MCLEOD DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2857
Mailing Address - Country:US
Mailing Address - Phone:989-921-1132
Mailing Address - Fax:989-921-1134
Practice Address - Street 1:2575 MCLEOD DR N
Practice Address - Street 2:SUITE B
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2857
Practice Address - Country:US
Practice Address - Phone:989-921-1132
Practice Address - Fax:989-921-1134
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005402174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699829119Medicaid
MI1699829119Medicaid