Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501008057 | MI |
NPI | 1003303710 |
---|---|
Provider Name | Thamilarasi Subramanian |
First Address | Pontiac, MI 48342-2217 |
Second Address | Pontiac, MI 48342-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |