Provider Demographics
NPI:1275080350
Name:SALEEM, NUMAN
Entity Type:Individual
Prefix:
First Name:NUMAN
Middle Name:
Last Name:SALEEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 BUNT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-1540
Mailing Address - Country:US
Mailing Address - Phone:317-654-9054
Mailing Address - Fax:
Practice Address - Street 1:1717 MAPLECREST RD
Practice Address - Street 2:APT # 112
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7656
Practice Address - Country:US
Practice Address - Phone:260-493-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005357A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant