Provider Demographics
NPI:1154550457
Name:SIDDIQUI, SHAHEEN (MSPT)
Entity type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 52
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3600
Mailing Address - Country:US
Mailing Address - Phone:623-398-8072
Mailing Address - Fax:623-398-8235
Practice Address - Street 1:610 N ALMA SCHOOL RD
Practice Address - Street 2:STE 52
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3600
Practice Address - Country:US
Practice Address - Phone:480-772-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist