MEDICARE: MISS PRASHANTI BISHAN SARUP SAXENA RPT

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	5501013644	MI

General Provider Information

NPI Number	:	1083892921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PRASHANTI BISHAN SARUP SAXENA RPT

Provider Business Mailing Address
First Line	:	5511 W US HIGHWAY 10
Second Line	:	SUITE # B
City	:	LUDINGTON
State	:	MI
Zip	:	49431-2455
Country	:	US
Telephone Number	:	989-560-7591
Fax Number	:

Provider Business Practice Location Address
First Line	:	4478 DOWLING ST
Second Line	:
City	:	MONTAGUE
State	:	MI
Zip	:	49437-1201
Country	:	US
Telephone Number	:	231-894-4531
Fax Number	:

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

Provider Enumeration Date	:	02/02/2008
Last Update Date	:	02/02/2008

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Directions to “ MISS PRASHANTI BISHAN SARUP SAXENA RPT” Practice Location

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