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General NPI Number Information
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NPI Number | 1780760652
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Entity Type | Organization
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Legal Business Name | MILLENIUM PHYSICAL THERAPY, PC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1641 LASALLE RD
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City | CANTON
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State | MI
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Zip | 48187-5823
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Country | US
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Telephone | 734-925-6161
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Fax | 734-844-1084
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Provider Business Mailing Address
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Address Line | 1641 LASALLE RD
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City | CANTON
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State | MI
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Zip | 48187
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Country | US
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Telephone | 734-925-6161
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Fax | 734-844-1084
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SWARUP SAHA
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Credential |
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Telephone | 734-925-6161
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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 | 5501008570
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License Number State | MI
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