MEDICARE: SHOBHAN VYAS

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
1	225100000X	Physical Therapist	5501014224	MI

General Provider Information

NPI Number	:	1760888721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOBHAN VYAS

Provider Business Mailing Address
First Line	:	30916 MORLOCK ST
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-1653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28480 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2820
Country	:	US
Telephone Number	:	248-327-6270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2014
Last Update Date	:	11/18/2014

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