Provider Demographics
NPI:1972827012
Name:SYED, IFTHAKAR AHMED (PT)
Entity Type:Individual
Prefix:
First Name:IFTHAKAR
Middle Name:AHMED
Last Name:SYED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2067 S LOVINGTON DR
Mailing Address - Street 2:APT 108
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4344
Mailing Address - Country:US
Mailing Address - Phone:857-869-2086
Mailing Address - Fax:
Practice Address - Street 1:24038 NOBLE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2720
Practice Address - Country:US
Practice Address - Phone:248-622-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist