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Organization
SPECIALIZED PHYSICAL THERAPY LLC
Active
Organization
SPECIALIZED PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KISHORE JEEVANANDAM PT (OWNER)
(313) 414-1042
Entity
Organization
Contact information
Practice address
49783 ANNANDALE DR, CANTON, MI 48187-2159
(313) 414-1042
Mailing address
49783 ANNANDALE DR, CANTON, MI 48187-2159
(313) 414-1042
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063981421
NPI- IND
—
01
—
1740578095
NPI- IND
—
Enumeration date
08/13/2020
Last updated
08/26/2020
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