Healthcare Provider Details

I. General information

NPI: 1679633259
Provider Name (Legal Business Name): NATRAJAN JAYARAMAN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE ST
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

33179 LOONEY DR
BROWNSTOWN MI
48173-8642
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-7732
  • Fax: 734-246-6071
Mailing address:
  • Phone: 734-379-7030
  • Fax: 734-379-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: