Provider Demographics
NPI:1013118835
Name:NOORUDDIN, MUHAMMAD SYED (PT)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SYED
Last Name:NOORUDDIN
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 1:7993 STEEPLECHASE CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3120
Mailing Address - Country:US
Mailing Address - Phone:863-801-1925
Mailing Address - Fax:863-763-6619
Practice Address - Street 1:7993 STEEPLECHASE CT
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3120
Practice Address - Country:US
Practice Address - Phone:863-801-1925
Practice Address - Fax:863-763-6619
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4951Medicare ID - Type Unspecified