Healthcare Provider Details

I. General information

NPI: 1932612520
Provider Name (Legal Business Name): MRS. MANYA SAXENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26400 W 12 MILE RD STE 25
SOUTHFIELD MI
48034-1774
US

IV. Provider business mailing address

13440 N 44TH ST APT 214
PHOENIX AZ
85032-6351
US

V. Phone/Fax

Practice location:
  • Phone: 248-565-4000
  • Fax: 248-565-4020
Mailing address:
  • Phone: 602-702-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1263115
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: