Provider Demographics
NPI:1235364670
Name:THANGARASAN, BASKARAN (PT)
Entity Type:Individual
Prefix:
First Name:BASKARAN
Middle Name:
Last Name:THANGARASAN
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 1:39348 POLO CLUB DR APT 106
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5635
Mailing Address - Country:US
Mailing Address - Phone:517-775-6552
Mailing Address - Fax:
Practice Address - Street 1:22011 ECORSE ROAD
Practice Address - Street 2:RESTORATIVE THERAPY SERVICE, INC
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-299-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist