Provider Demographics
NPI:1750620142
Name:THAKKER, JIMIN (PT)
Entity type:Individual
Prefix:
First Name:JIMIN
Middle Name:
Last Name:THAKKER
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 1:596 E BIG BEAVER RD APT 205
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1359
Mailing Address - Country:US
Mailing Address - Phone:248-513-1767
Mailing Address - Fax:
Practice Address - Street 1:28157 DEQUINDRE RD STE A1
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3046
Practice Address - Country:US
Practice Address - Phone:248-980-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist