Provider Demographics
NPI:1801114475
Name:MIRZA, SAIFULLA BAIG (RPT)
Entity type:Individual
Prefix:MR
First Name:SAIFULLA
Middle Name:BAIG
Last Name:MIRZA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3342
Mailing Address - Country:US
Mailing Address - Phone:708-271-7371
Mailing Address - Fax:
Practice Address - Street 1:248 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3342
Practice Address - Country:US
Practice Address - Phone:708-271-7371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist