Provider Demographics
NPI:1154553881
Name:UDDIN, SAMAH FIROZ (DPT)
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:FIROZ
Last Name:UDDIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W MAIN ST
Mailing Address - Street 2:120
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1547
Mailing Address - Country:US
Mailing Address - Phone:248-347-1168
Mailing Address - Fax:248-347-1252
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:120
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1547
Practice Address - Country:US
Practice Address - Phone:248-347-1168
Practice Address - Fax:248-347-1252
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT248862251X0800X
MI5501015859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic