Individual
EAPEN M CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
37677 PROFESSIONAL CENTER DR, SUITE 130 C, LIVONIA, MI 48154-1192
(734) 838-0772
(734) 838-0773
Mailing address
37677 PROFESSIONAL CENTER DR, SUITE 130 C, LIVONIA, MI 48154-1192
(734) 838-0772
(734) 838-0773
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4380955
—
MI
Enumeration date
08/24/2006
Last updated
03/13/2008
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