Provider Demographics
NPI:1952531832
Name:ZINZUVADIA, CHINMAY K (PT, DPT, CIMT)
Entity Type:Individual
Prefix:
First Name:CHINMAY
Middle Name:K
Last Name:ZINZUVADIA
Suffix:
Gender:M
Credentials:PT, DPT, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 LAKE LANSING RD
Mailing Address - Street 2:STE B
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3707
Mailing Address - Country:US
Mailing Address - Phone:517-483-2734
Mailing Address - Fax:517-483-2840
Practice Address - Street 1:1568 LAKE LANSING RD
Practice Address - Street 2:STE B
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3707
Practice Address - Country:US
Practice Address - Phone:517-483-2734
Practice Address - Fax:517-483-2840
Is Sole Proprietor?:No
Enumeration Date:2009-07-25
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist