Individual provider Active NPI

Sameena Kulsum Syed, PT

  • Physical Therapist
  • Lake Orion, MI
National Provider Identifier
1215128947
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501011031 Issued in MI
Practice address
4405 S Baldwin Rd Ste E
Lake Orion, MI 48359-2164
Phone
(248) 972-5008
Fax
(888) 614-2006
NPI assigned
Aug 7, 2007
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501011031 MI Primary

Addresses

Primary practice location

4405 S Baldwin Rd Ste E
Lake Orion, MI 48359-2164

Mailing address

2661 Aubrey Dr
Lake Orion, MI 48360-2702
Phone (248) 212-4203

Other practice location 1

15979 Hall Rd Ste 150
Macomb, MI 48044-5362
Phone (586) 416-8430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070907000415 MI Practitioner - Physical Therapist in Private Practice 2668565698 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kulsum Pelvic Rehab Services Physical Therapist CurrentSince Sep 23, 2024 Accepting new patients
Lake Orion Center for Pelvic Rehabilitation Physical Therapist CurrentSince Nov 3, 2023 Accepting new patients
William Beaumont Hospital Past Accepting new patients
Genesys Regional Medical Center Physical Therapist Past Accepting new patients

Locations

4405 S Baldwin Rd
Ste E
Lake Orion, MI 48359
Phone (248) 972-5088

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1215128947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2661 AUBREY DR",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483602702",
            "telephone_number": "248-212-4203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 S BALDWIN RD STE E",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483592164",
            "telephone_number": "248-972-5008",
            "fax_number": "888-614-2006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15979 Hall Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Macomb",
            "state": "MI",
            "postal_code": "480445362",
            "country_code": "US",
            "telephone_number": "586-416-8430",
            "fax_number": "586-416-8440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SYED",
        "first_name": "SAMEENA",
        "middle_name": "KULSUM",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501011031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.