Organization Active NPI

Physical Therapy Southfield, P.C.

  • Physical Therapist
  • Southfield, MI
National Provider Identifier
1922072974
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL THERAPY SOUTHFIELD, P.C.
Practice address
23077 Greenfield Rd
Suite 250
Southfield, MI 48075-3709
Phone
(248) 557-7336
Fax
(248) 557-4544
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Authorized official

Name
Noman Siddique
Title
Ceo
Phone
(313) 598-1155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

23077 Greenfield Rd
Suite 250
Southfield, MI 48075-3709

Mailing address

23077 Greenfield Rd
Suite 250
Southfield, MI 48075-3709
Phone (248) 557-7336

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000555 MI Part B Supplier - Clinic/Group Practice 9638075427 Receives reassigned benefits from 2 practitioners
Practice locations: Southfield, MI; Wayne, MI

National Provider Directory

National Provider Directory

Locations

23077 Greenfield Rd
Ste 250
Southfield, MI 48075
Phone (248) 424-8888

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1922072974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD",
            "address_2": "SUITE 250",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753709",
            "telephone_number": "248-557-7336",
            "fax_number": "248-557-4544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23077 GREENFIELD RD",
            "address_2": "SUITE 250",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753709",
            "telephone_number": "248-557-7336",
            "fax_number": "248-557-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY SOUTHFIELD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "NOMAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "313-598-1155"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.