Provider Demographics
NPI:1750480414
Name:NARAYAN, ASHIMA (PT)
Entity Type:Individual
Prefix:
First Name:ASHIMA
Middle Name:
Last Name:NARAYAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39885 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2151
Mailing Address - Country:US
Mailing Address - Phone:248-615-0282
Mailing Address - Fax:248-615-0415
Practice Address - Street 1:39885 GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2151
Practice Address - Country:US
Practice Address - Phone:248-615-0282
Practice Address - Fax:248-615-0415
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015176225100000X
MI5501015090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02749Medicare PIN
IL568080Medicare PIN
ILR02747Medicare PIN
IL567700Medicare PIN
ILR02748Medicare PIN
IL568150Medicare PIN