MEDICARE: MUTHUVINAYAGAM MURUGAN 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	5501007626	MI

General Provider Information

NPI Number	:	1194845792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUTHUVINAYAGAM MURUGAN RPT

Provider Business Mailing Address
First Line	:	3048 OAK MOSS CT
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3865
Country	:	US
Telephone Number	:	810-385-9366
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 LAPEER RD STE B101
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3013
Country	:	US
Telephone Number	:	810-984-4131
Fax Number	:	810-984-1612

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	01/15/2024

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