Organization
CAPITAL PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EAPEN M CHACKO PT (ADMINISTRATOR)
(734) 838-0772
Entity
Organization
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
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
EC005562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4380955
—
MI
Enumeration date
10/01/2006
Last updated
01/30/2008
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