Provider Demographics
NPI:1487730826
Name:JAHANGIR, ANEELA (RPT)
Entity type:Individual
Prefix:
First Name:ANEELA
Middle Name:
Last Name:JAHANGIR
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3391
Mailing Address - Country:US
Mailing Address - Phone:248-982-2775
Mailing Address - Fax:
Practice Address - Street 1:24537 OLDE ORCHARD ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2977
Practice Address - Country:US
Practice Address - Phone:248-478-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006228225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501006228OtherPHYSICAL THERAPY LICENSE