Provider Demographics
NPI:1700542263
Name:SIDDIQUI, MUHAMMAD R (PTA)
Entity type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:R
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1923 NEW CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6550
Mailing Address - Country:US
Mailing Address - Phone:248-275-3434
Mailing Address - Fax:866-571-6392
Practice Address - Street 1:15608 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-2852
Practice Address - Country:US
Practice Address - Phone:248-796-8159
Practice Address - Fax:866-571-6392
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004853225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant