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General NPI Number Information
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NPI Number | 1225255367
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Entity Type | Individual
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Provider Name | SHIVAKUMAR SUBBARAYAN RPT
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 3076 NORTHRIDGE RD
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City | HALE
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State | MI
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Zip | 48739-9277
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Country | US
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Telephone | 989-728-0242
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Fax | 989-728-1144
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Provider Business Mailing Address
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Address Line | 3076 NORTHRIDGE RD
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City | HALE
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State | MI
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Zip | 48739-9277
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Country | US
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Telephone | 989-728-0242
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Fax | 989-728-1144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5501008794
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License Number State | MI
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