Provider Demographics
NPI:1205158334
Name:GANDHI-SUBRAMANIAN, SUBBIAH (PT)
Entity type:Individual
Prefix:MR
First Name:SUBBIAH
Middle Name:
Last Name:GANDHI-SUBRAMANIAN
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 1:4745 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48210-3247
Mailing Address - Country:US
Mailing Address - Phone:313-899-3703
Mailing Address - Fax:313-899-3713
Practice Address - Street 1:4745 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3247
Practice Address - Country:US
Practice Address - Phone:313-899-3703
Practice Address - Fax:313-899-3713
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist