Provider Demographics
NPI:1235589045
Name:SHANKAR, LAKSHMI (PT, DSCPT, OMPT,)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:PT, DSCPT, OMPT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR SPC 5056
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5056
Mailing Address - Country:US
Mailing Address - Phone:734-936-7578
Mailing Address - Fax:
Practice Address - Street 1:325 E EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3364
Practice Address - Country:US
Practice Address - Phone:734-763-6464
Practice Address - Fax:734-763-3715
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25210225100000X
MI5501004623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist