Provider Demographics
NPI:1205968294
Name:UNIVERSAL PHYSICAL THERAPY SERVICES, P.C.
Entity type:Organization
Organization Name:UNIVERSAL PHYSICAL THERAPY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VISWANATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-894-4106
Mailing Address - Street 1:28105 DECLARATION RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2546
Mailing Address - Country:US
Mailing Address - Phone:248-449-7281
Mailing Address - Fax:313-894-7374
Practice Address - Street 1:5407 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3033
Practice Address - Country:US
Practice Address - Phone:313-894-4106
Practice Address - Fax:313-894-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON63600Medicare ID - Type Unspecified