Healthcare Provider Details

I. General information

NPI: 1881195808
Provider Name (Legal Business Name): AMIT SAXENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 02/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KIRTS BLVD STE 200
TROY MI
48084-4140
US

IV. Provider business mailing address

1302 BURNS DR
TROY MI
48083-6313
US

V. Phone/Fax

Practice location:
  • Phone: 248-591-0265
  • Fax:
Mailing address:
  • Phone: 248-686-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501008511
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: