Provider Demographics
NPI:1760858229
Name:TIWARI, ARCHANA (DPT)
Entity Type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:TIWARI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 BURNS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6317
Mailing Address - Country:US
Mailing Address - Phone:248-743-2856
Mailing Address - Fax:
Practice Address - Street 1:1259 BURNS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6317
Practice Address - Country:US
Practice Address - Phone:248-743-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI464115399193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty