Healthcare Provider Details

I. General information

NPI: 1922675479
Provider Name (Legal Business Name): NEHAL KOTHARI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E 10 MILD RD SUITE 137
EASTPOINTE MI
48021
US

IV. Provider business mailing address

43285 POLO CIRCLE APT #6
STERLING HEIGHTS MI
48313
US

V. Phone/Fax

Practice location:
  • Phone: 269-589-9659
  • Fax: 888-845-5090
Mailing address:
  • Phone: 313-420-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501020001
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: