MEDICARE: NEELAM THAWANI 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	5501015202	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5501015202	OTHER	MI	MI LICENCE NUMBER
2	0F39911	OTHER	MI	BCBSM PIN

General Provider Information

NPI Number	:	1376855791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEELAM THAWANI P.T

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10636 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1969
Country	:	US
Telephone Number	:	313-862-1340
Fax Number	:	313-862-1329

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

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	03/17/2025

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Directions to “ NEELAM THAWANI P.T” Practice Location

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