Provider Demographics
NPI:1780469668
Name:TARIQ, HADIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:HADIA
Middle Name:
Last Name:TARIQ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3073 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7010
Mailing Address - Country:US
Mailing Address - Phone:517-990-6211
Mailing Address - Fax:517-990-6212
Practice Address - Street 1:3108 E MICHIGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4642
Practice Address - Country:US
Practice Address - Phone:517-784-0037
Practice Address - Fax:517-990-6212
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C33574OtherBCBS