Provider Demographics
NPI:1538389697
Name:JOHRI, VIKAS (PT)
Entity type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:JOHRI
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 1:3323 SHATTUCK RD
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3184
Mailing Address - Country:US
Mailing Address - Phone:989-341-1919
Mailing Address - Fax:989-341-1920
Practice Address - Street 1:3323 SHATTUCK RD
Practice Address - Street 2:SUITE # 2
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3184
Practice Address - Country:US
Practice Address - Phone:989-341-1919
Practice Address - Fax:989-341-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45530008Medicare PIN
MIP45540008Medicare PIN