Provider Demographics
NPI:1154668119
Name:JOSEPH, NINAN (PT)
Entity Type:Individual
Prefix:
First Name:NINAN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41560 PHEASANT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-5201
Mailing Address - Country:US
Mailing Address - Phone:248-880-4190
Mailing Address - Fax:
Practice Address - Street 1:41560 PHEASANT CREEK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-5201
Practice Address - Country:US
Practice Address - Phone:248-880-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist