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General NPI Number Information
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NPI Number | 1205968294
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Entity Type | Organization
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Legal Business Name | UNIVERSAL PHYSICAL THERAPY SERVICES, P.C.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5407 MICHIGAN AVE
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City | DETROIT
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State | MI
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Zip | 48210-3033
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Country | US
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Telephone | 313-894-4106
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Fax | 313-894-7374
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Provider Business Mailing Address
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Address Line | 28105 DECLARATION RD
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City | NOVI
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State | MI
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Zip | 48377-2546
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Country | US
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Telephone | 248-449-7281
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Fax | 313-894-7374
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Authorized Official
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Title or Position | PRESIDENT
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Name | VISWANATHAN VENKATASWAMY
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Credential | P.T.
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Telephone | 313-894-4106
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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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