Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501014740 | MI |
NPI | 1407148372 |
---|---|
Provider Name | Devashish Tiwari |
First Address | Caro, MI 48723-9221 |
Second Address | Caro, MI 48723-9221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 10/05/2011 |