Gaurav Mitra
Physical Therapist in Imlay City, MI. Individual provider (NPI-1).
NPI number1104078443
StatusActive
Last updated in NPPESMar 24, 2009
Details
- NPI
- 1104078443
- Entity type
- Individual (NPI-1)
- Name
- Gaurav Mitra
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 17, 2008
- Last updated
- Mar 24, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 5501013172 | MI | Yes |
Practice location
1769 S Cedar StImlay City, MI 48444-1300
Phone 810-724-0421 · Fax 810-721-0423
Mailing address
1769 S Cedar StImlay City, MI 48444-1300
Phone 810-724-0421 · Fax 810-721-0423
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 10 Physical Therapist providers in Imlay City · All 136 providers in Imlay City
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