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General NPI Number Information
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NPI Number | 1265607782
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Entity Type | Individual
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Provider Name | BABITHA JACOB PT
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Gender | Female
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 44000 W 12 MILE RD SUITE 205
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City | NOVI
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State | MI
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Zip | 48377-2647
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Country | US
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Telephone | 248-465-0100
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Fax | 248-465-0107
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Provider Business Mailing Address
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Address Line | 1560 E MAPLE RD SUITE 400 - CREDENTIALING DEPARTMENT
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City | TROY
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State | MI
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Zip | 48083-1189
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Country | US
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Telephone | 248-465-0100
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Fax |
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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 | 5501011959
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License Number State | MI
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