Provider Demographics
NPI:1215128947
Name:SYED, SAMEENA KULSUM (PT)
Entity type:Individual
Prefix:
First Name:SAMEENA
Middle Name:KULSUM
Last Name:SYED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 AUBREY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2702
Mailing Address - Country:US
Mailing Address - Phone:248-212-4203
Mailing Address - Fax:
Practice Address - Street 1:4405 S BALDWIN RD STE E
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2164
Practice Address - Country:US
Practice Address - Phone:248-972-5008
Practice Address - Fax:888-614-2006
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45530035Medicare PIN