MEDICARE: PAUL BHUPAL CHANDANSHIVE P.T

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	5501018012	MI

General Provider Information

NPI Number	:	1063929842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BHUPAL CHANDANSHIVE P.T

Provider Business Mailing Address
First Line	:	105 W HOUGHTON AVE
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-1286
Country	:	US
Telephone Number	:	989-343-9755
Fax Number	:	989-343-9955

Provider Business Practice Location Address
First Line	:	105 W HOUGHTON AVE
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-1286
Country	:	US
Telephone Number	:	989-343-9755
Fax Number	:	989-343-9955

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/03/2018

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