Healthcare Provider Details

I. General information

NPI: 1235589045
Provider Name (Legal Business Name): LAKSHMI SHANKAR PT, DSCPT, OMPT,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E EISENHOWER PKWY
ANN ARBOR MI
48108-3364
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR SPC 5056
ANN ARBOR MI
48109-5056
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-6464
  • Fax: 734-763-3715
Mailing address:
  • Phone: 734-936-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 25210
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501004623
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: