Healthcare Provider Details

I. General information

NPI: 1992093850
Provider Name (Legal Business Name): JOHN PUTNAM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 ROCHESTER RD
ROYAL OAK MI
48073-3635
US

IV. Provider business mailing address

2512 ROCHESTER RD
ROYAL OAK MI
48073-3635
US

V. Phone/Fax

Practice location:
  • Phone: 248-733-4325
  • Fax:
Mailing address:
  • Phone: 248-733-4325
  • Fax: 248-268-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: