Provider Demographics
NPI:1972124741
Name:GEORGE, PRITI M (DSCPT, COMT, OCS)
Entity Type:Individual
Prefix:DR
First Name:PRITI
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DSCPT, COMT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48245 BINGHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8685
Mailing Address - Country:US
Mailing Address - Phone:248-675-5927
Mailing Address - Fax:
Practice Address - Street 1:48245 BINGHAMPTON CT
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8685
Practice Address - Country:US
Practice Address - Phone:248-675-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty