MEDICARE: ANJU ABRAHAM PT

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	5501012537	MI

General Provider Information

NPI Number	:	1174707400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJU ABRAHAM PT

Provider Business Mailing Address
First Line	:	11554 E 12 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-2644
Country	:	US
Telephone Number	:	586-558-0185
Fax Number	:	586-558-7128

Provider Business Practice Location Address
First Line	:	39591 GARFIELD RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4300
Country	:	US
Telephone Number	:	586-412-4964
Fax Number	:	586-412-6995

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

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	08/11/2008

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