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NPI Code Detail

MEDICARE: EDWARD GLADSTON PRAGASAM

MEDICARE: EDWARD GLADSTON PRAGASAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501012546MI
2225100000XPhysical Therapist26005MD

General Provider Information

NPI Number : 1326272626
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD GLADSTON PRAGASAM
Provider Business Mailing Address
First Line : 900 AUBURN AVE
Second Line :
City : PONTIAC
State : MI
Zip : 48342-3300
Country : US
Telephone Number : 248-333-3335
Fax Number : 248-333-7133
Provider Business Practice Location Address
First Line : 900 AUBURN AVE
Second Line :
City : PONTIAC
State : MI
Zip : 48342-3300
Country : US
Telephone Number : 248-333-3335
Fax Number : 248-333-7133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2009
Last Update Date : 02/28/2017

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Directions to “ EDWARD GLADSTON PRAGASAM ” Practice Location

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