Provider Demographics
NPI:1033527940
Name:MANDAPAT, JOSEPH (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MANDAPAT
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45514 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6080
Mailing Address - Country:US
Mailing Address - Phone:248-990-6095
Mailing Address - Fax:
Practice Address - Street 1:45514 REVERE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6080
Practice Address - Country:US
Practice Address - Phone:248-990-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist