Healthcare Provider Details

I. General information

NPI: 1578107595
Provider Name (Legal Business Name): NAGARAJENDRA BABU PALAPATI PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52188 VAN DYKE AVE STE 308
SHELBY TWP MI
48316-3567
US

IV. Provider business mailing address

52188 VAN DYKE AVE STE 308
SHELBY TWP MI
48316-3567
US

V. Phone/Fax

Practice location:
  • Phone: 248-829-6527
  • Fax: 248-920-8064
Mailing address:
  • Phone: 248-826-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: