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General NPI Number Information
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NPI Number | 1669709796
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Entity Type | Individual
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Provider Name | SRINIVASU SEELAM B.P.T
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Gender | Male
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 2815 S PENNSYLVANIA AVE STE 4
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City | LANSING
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State | MI
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Zip | 48910-3496
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Country | US
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Telephone | 517-975-9900
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Fax | 517-975-9913
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Provider Business Mailing Address
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Address Line | 2375 CLUB MERIDIAN DR APT 4B
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City | OKEMOS
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State | MI
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Zip | 48864-4522
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Country | US
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Telephone | 215-760-9071
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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 | 5501014016
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License Number State | MI
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