Healthcare Provider Details

I. General information

NPI: 1821594888
Provider Name (Legal Business Name): GOMATHI ANANDHARAMANUJAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EARHART RD
ANN ARBOR MI
48105-2768
US

IV. Provider business mailing address

51105 GULFSTREAM PARK LN
CANTON MI
48188-2593
US

V. Phone/Fax

Practice location:
  • Phone: 734-769-6410
  • Fax:
Mailing address:
  • Phone: 989-980-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: