Provider Demographics
NPI:1780642025
Name:BRAHMBHATT, MANOJ JAYDEVBHAI (PT)
Entity Type:Individual
Prefix:MR
First Name:MANOJ
Middle Name:JAYDEVBHAI
Last Name:BRAHMBHATT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 W CARO RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-9221
Mailing Address - Country:US
Mailing Address - Phone:989-975-1770
Mailing Address - Fax:989-269-8715
Practice Address - Street 1:1004 W CARO RD
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9221
Practice Address - Country:US
Practice Address - Phone:989-975-1770
Practice Address - Fax:989-269-8715
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010079771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M89010Medicare PIN