Individual
MR. JIMMY BHADRESH KUMAR KOTAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
29125 BUCKINGHAM ST, SUITE 2A, LIVONIA, MI 48154-4480
(248) 565-4000
(248) 565-4030
Mailing address
29125 BUCKINGHAM ST, SUITE 2A, LIVONIA, MI 48154-4480
(248) 565-4000
(248) 565-4030
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004838
MI
Other
Enumeration date
02/24/2016
Last updated
02/24/2016
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