Provider Demographics
NPI:1699220061
Name:TARIQ, SAMEEN (DPT)
Entity Type:Individual
Prefix:
First Name:SAMEEN
Middle Name:
Last Name:TARIQ
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 1:6101 S COUNTY LINE RD
Mailing Address - Street 2:STE 57
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8132
Mailing Address - Country:US
Mailing Address - Phone:630-230-9565
Mailing Address - Fax:
Practice Address - Street 1:625 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8813
Practice Address - Country:US
Practice Address - Phone:630-575-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26096225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist