MEDICARE: MR. GOVINDARAJU ANBUSELVAN 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	5501007049	MI

General Provider Information

NPI Number	:	1801928890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GOVINDARAJU ANBUSELVAN P.T.

Provider Business Mailing Address
First Line	:	28105 DECLARATION RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2546
Country	:	US
Telephone Number	:	248-449-7281
Fax Number	:	313-894-7374

Provider Business Practice Location Address
First Line	:	5407 MICHIGAN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-3033
Country	:	US
Telephone Number	:	313-894-4106
Fax Number	:	313-894-7374

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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