Healthcare Provider Details

I. General information

NPI: 1598084501
Provider Name (Legal Business Name): MIHIRKUMAR BALMUKUND TRIVEDI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 N MICHIGAN RD
DIMONDALE MI
48821-9744
US

IV. Provider business mailing address

6846 CASTLETON DR
GRAND LEDGE MI
48837-8738
US

V. Phone/Fax

Practice location:
  • Phone: 517-646-6258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: