Healthcare Provider Details

I. General information

NPI: 1922072974
Provider Name (Legal Business Name): PHYSICAL THERAPY SOUTHFIELD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23077 GREENFIELD RD SUITE 250
SOUTHFIELD MI
48075-3709
US

IV. Provider business mailing address

23077 GREENFIELD RD SUITE 250
SOUTHFIELD MI
48075-3709
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-7336
  • Fax: 248-557-4544
Mailing address:
  • Phone: 248-557-7336
  • Fax: 248-557-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NOMAN SIDDIQUE
Title or Position: CEO
Credential:
Phone: 313-598-1155