Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501007326 | MI |
N | 2251C2600X | Cardiopulmonary | 5501007326 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 5501007326 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501007326 | MI |
NPI | 1619094034 |
---|---|
Provider Name | Mr. Sujoy Bose |
First Address | Brownstown, MI 48183-2796 |
Second Address | Detroit, MI 48201-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 28/02/2008 |