Provider Demographics
NPI:1922072974
Name:PHYSICAL THERAPY SOUTHFIELD, P.C.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SOUTHFIELD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-598-1155
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-557-7336
Mailing Address - Fax:248-557-4544
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 250
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-557-7336
Practice Address - Fax:248-557-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M84170Medicare UPIN