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Individual

SHIVA SHANKAR TRIVEDI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
5917 ENDICOTT DR, TROY, MI 48085-3805
(309) 569-1395
Mailing address
5917 ENDICOTT DR, TROY, MI 48085-3805
(309) 569-1395

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
011442
NY
225200000X
Physical Therapy Assistant
Primary
5502005847
MI

Other

Enumeration date
10/02/2018
Last updated
02/08/2024
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