Provider Demographics
NPI:1073849881
Name:NAGARWAL, AMIT KUMAR (RPT)
Entity Type:Individual
Prefix:MR
First Name:AMIT
Middle Name:KUMAR
Last Name:NAGARWAL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26440 HOOVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1190
Mailing Address - Country:US
Mailing Address - Phone:586-756-7500
Mailing Address - Fax:586-619-9035
Practice Address - Street 1:26440 HOOVER RD STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1190
Practice Address - Country:US
Practice Address - Phone:586-756-7500
Practice Address - Fax:586-619-9035
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014445OtherSTATE OF MICHIGAN BOARD OF PHYSICAL THERAPY