Healthcare Provider Details

I. General information

NPI: 1497668669
Provider Name (Legal Business Name): JONATHAN VU PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DECKER RD
COMMERCE TOWNSHIP MI
48390-3625
US

IV. Provider business mailing address

23739 STONEHENGE BLVD
NOVI MI
48375-3778
US

V. Phone/Fax

Practice location:
  • Phone: 248-896-1400
  • Fax:
Mailing address:
  • Phone: 313-247-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008384
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: