Basic Information
| Provider Information | |||||||||
| NPI: | 1386741437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIN | ||||||||
| FirstName: | RAJIV | ||||||||
| MiddleName: | PRAMOD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37699 6 MILE RD | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349534155 | ||||||||
| FaxNumber: | 7349531622 | ||||||||
| Practice Location | |||||||||
| Address1: | 37699 6 MILE RD | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349534155 | ||||||||
| FaxNumber: | 7349531622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501010212 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 650H257950 | 01 | MI | BCBS-PHYSICAL THERAPY | OTHER | 0N26170 | 01 | MI | MEDICARE PTAN | OTHER | 383578878 | 01 | MI | PPOM | OTHER |