Provider Demographics
NPI:1356419261
Name:AHMED, SURAIYA (PT)
Entity type:Individual
Prefix:MRS
First Name:SURAIYA
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7365 CARNELIAN ST STE 124
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1156
Mailing Address - Country:US
Mailing Address - Phone:909-948-2080
Mailing Address - Fax:909-948-2083
Practice Address - Street 1:7365 CARNELIAN ST STE 124
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1156
Practice Address - Country:US
Practice Address - Phone:909-948-2080
Practice Address - Fax:909-948-2083
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist