Provider Demographics
NPI:1376024158
Name:SYAMALA, ARUN GOPALAKRISHNAN (PT)
Entity Type:Individual
Prefix:MR
First Name:ARUN
Middle Name:GOPALAKRISHNAN
Last Name:SYAMALA
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 1:227 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1412
Mailing Address - Country:US
Mailing Address - Phone:732-668-3037
Mailing Address - Fax:
Practice Address - Street 1:45900 GEDDES RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2306
Practice Address - Country:US
Practice Address - Phone:734-879-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist