Provider Demographics
NPI:1376855791
Name:THAWANI, NEELAM (PT)
Entity Type:Individual
Prefix:
First Name:NEELAM
Middle Name:
Last Name:THAWANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NEELAM
Other - Middle Name:
Other - Last Name:KARAMCHANDANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-1144
Mailing Address - Country:US
Mailing Address - Phone:231-873-3577
Mailing Address - Fax:231-873-3557
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-1144
Practice Address - Country:US
Practice Address - Phone:231-873-3577
Practice Address - Fax:231-873-3557
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F39911OtherBCBSM PIN
MI5501015202OtherMI LICENCE NUMBER