Provider Demographics
NPI:1932601598
Name:CHERIAN, EAPEN KAPPAMMOOTTIL (PT)
Entity Type:Individual
Prefix:
First Name:EAPEN
Middle Name:KAPPAMMOOTTIL
Last Name:CHERIAN
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 1:2003 FOREST MEAD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2733
Mailing Address - Country:US
Mailing Address - Phone:248-376-0864
Mailing Address - Fax:
Practice Address - Street 1:18200 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5446
Practice Address - Country:US
Practice Address - Phone:248-647-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist