=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215128947
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMEENA KULSUM SYED PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2007
-----------------------------------------------------
Last Update Date | 09/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4405 S BALDWIN RD STE E
-----------------------------------------------------
City | LAKE ORION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48359-2164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-972-5008
-----------------------------------------------------
Fax | 888-614-2006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2661 AUBREY DR
-----------------------------------------------------
City | LAKE ORION
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48360-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-212-4203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501011031
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------