Provider Demographics
NPI:1760794937
Name:HUSSAIN, SYED A (RPT)
Entity Type:Individual
Prefix:MR
First Name:SYED
Middle Name:A
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 VILLAGE PLACE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3378
Mailing Address - Country:US
Mailing Address - Phone:248-520-4997
Mailing Address - Fax:
Practice Address - Street 1:5115 VILLAGE PLACE CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3378
Practice Address - Country:US
Practice Address - Phone:248-520-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist