Provider Demographics
NPI:1760659460
Name:JHA, JAY SHANKAR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:SHANKAR
Last Name:JHA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10809 MACK AVE
Mailing Address - Street 2:SUITE PT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2119
Mailing Address - Country:US
Mailing Address - Phone:313-331-2100
Mailing Address - Fax:313-331-2101
Practice Address - Street 1:10809 MACK AVE
Practice Address - Street 2:SUITE PT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-2119
Practice Address - Country:US
Practice Address - Phone:313-331-2100
Practice Address - Fax:313-331-2101
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N66400Medicare PIN