Provider Demographics
NPI:1083892921
Name:SAXENA, PRASHANTI BISHAN SARUP (RPT)
Entity Type:Individual
Prefix:MISS
First Name:PRASHANTI
Middle Name:BISHAN SARUP
Last Name:SAXENA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-560-7591
Mailing Address - Fax:
Practice Address - Street 1:4478 DOWLING ST
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1201
Practice Address - Country:US
Practice Address - Phone:231-894-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist