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NPI Code Detail

MEDICARE: HONEY CHEMPITHANAM JACOB PHYSICAL THERAPIST

MEDICARE: HONEY CHEMPITHANAM JACOB PHYSICAL THERAPIST
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
1225100000XPhysical Therapist5501014322MI

General Provider Information

NPI Number : 1700389541
Entity Type Code : Individual
Provider Name (Legal Business Name) : HONEY CHEMPITHANAM JACOB PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 1701 PINE FOREST DR
Second Line :
City : COMMERCE TOWNSHIP
State : MI
Zip : 48390-2221
Country : US
Telephone Number : 248-504-7955
Fax Number :
Provider Business Practice Location Address
First Line : 6700 W OUTER DR
Second Line :
City : DETROIT
State : MI
Zip : 48235-2724
Country : US
Telephone Number : 313-836-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 03/16/2018

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Directions to “ HONEY CHEMPITHANAM JACOB PHYSICAL THERAPIST” Practice Location

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