Provider Demographics
NPI:1144523747
Name:KINTHALI, BHAGYA LAXMI (PT)
Entity type:Individual
Prefix:MS
First Name:BHAGYA
Middle Name:LAXMI
Last Name:KINTHALI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14710 W WARREN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1347
Mailing Address - Country:US
Mailing Address - Phone:313-584-2873
Mailing Address - Fax:313-528-4693
Practice Address - Street 1:14710 W WARREN AVE STE B
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1347
Practice Address - Country:US
Practice Address - Phone:313-584-2873
Practice Address - Fax:313-528-4693
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist