Provider Demographics
NPI:1518312982
Name:FUMAKIYA, BHARATKUMAR H (PT)
Entity Type:Individual
Prefix:
First Name:BHARATKUMAR
Middle Name:H
Last Name:FUMAKIYA
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 1:1095 CANTERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3807
Mailing Address - Country:US
Mailing Address - Phone:214-620-1267
Mailing Address - Fax:
Practice Address - Street 1:8409 BROOKE PARK DRIVE
Practice Address - Street 2:APT 112
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4078
Practice Address - Country:US
Practice Address - Phone:214-620-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15713225100000X
MI5501015359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist