MEDICARE: MR. SAIFULLA BAIG MIRZA RPT

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	007901	CT

General Provider Information

NPI Number	:	1801114475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAIFULLA BAIG MIRZA RPT

Provider Business Mailing Address
First Line	:	248 MAPLE AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3342
Country	:	US
Telephone Number	:	708-271-7371
Fax Number	:

Provider Business Practice Location Address
First Line	:	248 MAPLE AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3342
Country	:	US
Telephone Number	:	708-271-7371
Fax Number	:

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

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	09/15/2016

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