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General NPI Number Information
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NPI Number | 1164648432
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Entity Type | Organization
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Legal Business Name | CENTER FOR SPORTS MEDICINE & FITNESS, INC.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 18535 W 12 MILE RD STE B
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2664
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Country | US
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Telephone | 248-353-3260
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Fax | 888-267-1867
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Provider Business Mailing Address
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Address Line | 18535 W 12 MILE RD STE B
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2664
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Country | US
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Telephone | 248-353-3260
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Fax | 888-267-1867
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Authorized Official
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Title or Position | PRESIDENT
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Name | VIVEK SHIRISHKAR
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Credential | P.T.
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Telephone | 248-353-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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