Provider Demographics
NPI:1922667948
Name:SIDDIQUI, BATOOL SUMMER (CPO)
Entity Type:Individual
Prefix:
First Name:BATOOL
Middle Name:SUMMER
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CHEEK SPARGER RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2204
Mailing Address - Country:US
Mailing Address - Phone:682-390-4499
Mailing Address - Fax:817-549-9460
Practice Address - Street 1:99 CHEEK SPARGER RD STE 104A
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-2204
Practice Address - Country:US
Practice Address - Phone:682-390-4499
Practice Address - Fax:817-549-9460
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1982222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982OtherTEXAS DEPARTMENT OF LICENSING & REGULATION
04188OtherCPO