Individual
DAMODHARAN PERAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2040 CASCADE WOODS DR, JACKSON, MI 49203-3773
(734) 233-7689
Mailing address
2040, CASCADES WOODS DR, JACKSON, MI 49203
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501014242
MI
225800000X
Recreation Therapist
5501014242
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5501014242
—
MI
Enumeration date
12/17/2018
Last updated
12/17/2018
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