MEDICARE: JINESH J ABRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501014925	MI

General Provider Information

NPI Number	:	1023517224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINESH J ABRAHAM

Provider Business Mailing Address
First Line	:	43151 VINTNERS PLACE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1334
Country	:	US
Telephone Number	:	954-303-0736
Fax Number	:

Provider Business Practice Location Address
First Line	:	43151 VINTNERS PLACE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1334
Country	:	US
Telephone Number	:	954-303-0736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2018
Last Update Date	:	02/03/2018

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