Provider Demographics
NPI:1780991570
Name:JOSHI, SHRUTI MADHAV
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:MADHAV
Last Name:JOSHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 FARNBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3548
Mailing Address - Country:US
Mailing Address - Phone:612-298-0886
Mailing Address - Fax:
Practice Address - Street 1:3000 CENTERPOINT PKWY
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-3116
Practice Address - Country:US
Practice Address - Phone:248-857-6776
Practice Address - Fax:248-857-7102
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INA00845675OtherLEWERMARK STUDENT HEALTH INSURANCE PLANS