MEDICARE: DANNY JACOB KANIYALY PT, DPT

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	070024508	IL

General Provider Information

NPI Number	:	1649826470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANNY JACOB KANIYALY PT, DPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1923 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4322
Country	:	US
Telephone Number	:	773-492-3880
Fax Number	:	773-492-3881

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

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	01/05/2026

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