Provider Demographics
NPI:1205007374
Name:FALTAS, SAMI (PT)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:FALTAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-733-1200
Mailing Address - Fax:810-733-3130
Practice Address - Street 1:1537 E HILL RD
Practice Address - Street 2:STE. 400
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5190
Practice Address - Country:US
Practice Address - Phone:810-603-1100
Practice Address - Fax:810-603-1101
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F32997OtherBLUE SHIELD OF MICHIGAN
P29910001Medicare PIN