Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501014457 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1295238129 |
---|---|
Provider Name | Manoj Verma |
First Address | Bad Axe, MI 48413-1347 |
Second Address | Bad Axe, MI 48413-1555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 16/03/2018 |