Provider Demographics
NPI:1093461451
Name:AZER, MARIHAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIHAM
Middle Name:
Last Name:AZER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIHAM
Other - Middle Name:
Other - Last Name:SAFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11543 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5001
Mailing Address - Country:US
Mailing Address - Phone:347-571-3145
Mailing Address - Fax:
Practice Address - Street 1:11543 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5001
Practice Address - Country:US
Practice Address - Phone:407-380-0357
Practice Address - Fax:407-380-0342
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046144-01225100000X
FL38001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist