Provider Demographics
NPI:1083019277
Name:EMPOWER PHYSICAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJENDRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THANGAMUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:248-890-8000
Mailing Address - Street 1:20554 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5326
Mailing Address - Country:US
Mailing Address - Phone:586-868-7000
Mailing Address - Fax:586-868-7007
Practice Address - Street 1:15501 METROPOLITAN PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1684
Practice Address - Country:US
Practice Address - Phone:586-228-7000
Practice Address - Fax:586-228-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003513225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty