Provider Demographics
NPI:1689790438
Name:PALANISWAMY, VASUDEVAN (RPT)
Entity Type:Individual
Prefix:MR
First Name:VASUDEVAN
Middle Name:
Last Name:PALANISWAMY
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 1:49800 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-6824
Mailing Address - Country:US
Mailing Address - Phone:248-787-6605
Mailing Address - Fax:248-449-1118
Practice Address - Street 1:29510 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1910
Practice Address - Country:US
Practice Address - Phone:248-427-9525
Practice Address - Fax:248-427-9528
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN84310002Medicare ID - Type UnspecifiedREGISTE PHYSICAL THERAPY