Marivenkatesh Balamanickam
Physical Therapist in Northville, MI. Individual provider (NPI-1).
NPI number1417101080
StatusActive
Last updated in NPPESNov 10, 2008
Details
- NPI
- 1417101080
- Entity type
- Individual (NPI-1)
- Name
- Marivenkatesh Balamanickam
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 10, 2008
- Last updated
- Nov 10, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 5501013805 | MI | Yes |
Practice location
235 E Main StSuite 104
Northville, MI 48167-2494
Phone 248-349-5050
Mailing address
235 E Main StSuite 104
Northville, MI 48167-2494
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