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General NPI Number Information
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NPI Number | 1306980735
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Entity Type | Individual
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Provider Name | GAUTAM ARORA PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2920 FULLER AVE NE SUITE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3458
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Country | US
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Telephone | 616-361-8355
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Fax | 616-361-8354
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Provider Business Mailing Address
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Address Line | 4265 ARLET CT SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8276
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Country | US
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Telephone | 616-285-9261
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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 | 5501006066
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License Number State | MI
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