Healthcare Provider Details

I. General information

NPI: 1225539489
Provider Name (Legal Business Name): APARNA PLOUCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 COOLIDGE HWY
ROYAL OAK MI
48073-1026
US

IV. Provider business mailing address

5041 LONGVIEW DR
TROY MI
48098-2350
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-3011
  • Fax:
Mailing address:
  • Phone: 248-930-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011461
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: