MEDICARE: SAMMARA RIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501017637	MI

General Provider Information

NPI Number	:	1710527676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMMARA RIAZ

Provider Business Mailing Address
First Line	:	1088 LAKE PARK DR
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-8073
Country	:	US
Telephone Number	:	248-756-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	G1069 N BALLENGER HWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48504-4431
Country	:	US
Telephone Number	:	810-235-6676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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