Provider Demographics
NPI:1982033064
Name:BHATT, MANAN
Entity Type:Individual
Prefix:
First Name:MANAN
Middle Name:
Last Name:BHATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S LOVINGTON DR
Mailing Address - Street 2:APT 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2209 S LOVINGTON DR
Practice Address - Street 2:APT 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4369
Practice Address - Country:US
Practice Address - Phone:734-389-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist