Provider Demographics
NPI:1780280883
Name:IYER, SHYAMALA (RPT)
Entity type:Individual
Prefix:
First Name:SHYAMALA
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 TOWN CENTER DR APT 152B
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3376
Mailing Address - Country:US
Mailing Address - Phone:352-474-8364
Mailing Address - Fax:
Practice Address - Street 1:343 INKSTER RD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1208
Practice Address - Country:US
Practice Address - Phone:352-474-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010019729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist