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General NPI Number Information
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NPI Number | 1346947116
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Entity Type | Organization
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Legal Business Name | SPINE AND AQUATIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 15240 MERRIMAN RD
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City | LIVONIA
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State | MI
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Zip | 48154-3570
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Country | US
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Telephone | 734-513-7755
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 703207
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City | PLYMOUTH
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State | MI
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Zip | 48170-0994
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SANJAY THAKRAL
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Credential | DPT
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Telephone | 734-513-7755
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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