Healthcare Provider Details

I. General information

NPI: 1154775237
Provider Name (Legal Business Name): PARTHASARATHY EAPPAKKAM KUMARASWAMY DSCPT, OCS, FAAOMPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/20/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 EXECUTIVE DR STE 3
LANSING MI
48911-5301
US

IV. Provider business mailing address

5700 EXECUTIVE DR STE 3
LANSING MI
48911-5301
US

V. Phone/Fax

Practice location:
  • Phone: 517-348-5155
  • Fax:
Mailing address:
  • Phone: 517-348-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015572
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: