Provider Demographics
NPI:1043309966
Name:MANIMALETHU, TOBY RAJU (RPT)
Entity Type:Individual
Prefix:MR
First Name:TOBY
Middle Name:RAJU
Last Name:MANIMALETHU
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20319 FARMINGTON RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1411
Mailing Address - Country:US
Mailing Address - Phone:248-476-8911
Mailing Address - Fax:248-476-8913
Practice Address - Street 1:20319 FARMINGTON RD BLDG E
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1411
Practice Address - Country:US
Practice Address - Phone:248-476-8911
Practice Address - Fax:248-476-8913
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383454355OtherOTHER INSURANCE PIN
MI650H257440OtherBCBS PIN
MI383606482OtherINSPIRATIONS TAX ID
MI650H257440OtherBCBS PIN