Healthcare Provider Details

I. General information

NPI: 1881599868
Provider Name (Legal Business Name): ORTHOPEDIC & SPINE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 STEEPLECHASE RD
CANTON MI
48188-2565
US

IV. Provider business mailing address

1842 STEEPLECHASE RD
CANTON MI
48188-2565
US

V. Phone/Fax

Practice location:
  • Phone: 517-862-6648
  • Fax:
Mailing address:
  • Phone: 517-862-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SOUNDARARAJAN DURAISAMY
Title or Position: OWNER
Credential:
Phone: 517-862-6648