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General NPI Number Information
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NPI Number | 1497668669
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Entity Type | Individual
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Provider Name | JONATHAN VU PTA
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Gender | Male
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 100 DECKER RD
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City | COMMERCE TOWNSHIP
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State | MI
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Zip | 48390-3625
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Country | US
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Telephone | 248-896-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 23739 STONEHENGE BLVD
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City | NOVI
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State | MI
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Zip | 48375-3778
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Country | US
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Telephone | 313-247-9196
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502008384
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License Number State | MI
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