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General NPI Number Information
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NPI Number | 1639249931
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Entity Type | Individual
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Provider Name | EDEWOR SPLENDID NANA PT
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 17500 NORTHLAND PARK CT STE 1
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4324
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Country | US
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Telephone | 313-388-7110
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Fax | 313-388-7424
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Provider Business Mailing Address
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Address Line | 17500 NORTHLAND PARK CT STE 1
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4324
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Country | US
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Telephone | 313-388-7110
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Fax | 313-388-7424
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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 | 5501006444
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License Number State | MI
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