MEDICARE: VISHNUPRADEEP MEDA 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	5501014430	MI

General Provider Information

NPI Number	:	1356654784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHNUPRADEEP MEDA PT

Provider Business Mailing Address
First Line	:	16820 GREENFIELD RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3703
Country	:	US
Telephone Number	:	313-273-7188
Fax Number	:

Provider Business Practice Location Address
First Line	:	16820 GREENFIELD RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3703
Country	:	US
Telephone Number	:	313-273-7188
Fax Number	:

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	07/14/2010

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Directions to “ VISHNUPRADEEP MEDA PT” Practice Location

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