Provider Demographics
NPI:1033354378
Name:DAVE, AMITBHAI K (PT)
Entity Type:Individual
Prefix:
First Name:AMITBHAI
Middle Name:K
Last Name:DAVE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W. WACKER DRIVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:49221-0000
Mailing Address - Country:US
Mailing Address - Phone:909-653-8336
Mailing Address - Fax:
Practice Address - Street 1:1136 COUNTRY CLUB RD
Practice Address - Street 2:SUITE A
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8208
Practice Address - Country:US
Practice Address - Phone:517-264-6141
Practice Address - Fax:517-263-5786
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist