Provider Demographics
NPI:1649771205
Name:KALAISENTHIL, VASANTHI
Entity Type:Individual
Prefix:
First Name:VASANTHI
Middle Name:
Last Name:KALAISENTHIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VASANTHI
Other - Middle Name:
Other - Last Name:SIVASANKARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:34005 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7222
Mailing Address - Country:US
Mailing Address - Phone:810-471-8407
Mailing Address - Fax:
Practice Address - Street 1:G3201 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3615
Practice Address - Country:US
Practice Address - Phone:810-732-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist