Provider Demographics
NPI:1144791393
Name:VEERAPPAN, SELVARAJU (RPT)
Entity Type:Individual
Prefix:
First Name:SELVARAJU
Middle Name:
Last Name:VEERAPPAN
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 1:20346 VINE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6501
Mailing Address - Country:US
Mailing Address - Phone:586-770-9512
Mailing Address - Fax:
Practice Address - Street 1:20346 VINE DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-6501
Practice Address - Country:US
Practice Address - Phone:586-770-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty