Provider Demographics
NPI:1467782300
Name:SAKTHIVEL, MUTHUKUMAR (RPT)
Entity Type:Individual
Prefix:
First Name:MUTHUKUMAR
Middle Name:
Last Name:SAKTHIVEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 CRIMSON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5510
Mailing Address - Country:US
Mailing Address - Phone:248-494-0491
Mailing Address - Fax:248-528-3208
Practice Address - Street 1:1889 CRIMSON DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5510
Practice Address - Country:US
Practice Address - Phone:248-494-0491
Practice Address - Fax:248-528-3208
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist