Provider Demographics
NPI:1861884561
Name:PAKIRU, SRIDHAR (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:PAKIRU
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33000 ANNAPOLIS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2920
Mailing Address - Country:US
Mailing Address - Phone:734-467-4134
Mailing Address - Fax:734-467-4699
Practice Address - Street 1:33000 ANNAPOLIS ST STE 210
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2920
Practice Address - Country:US
Practice Address - Phone:734-467-4134
Practice Address - Fax:734-467-4699
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
MI5501012584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501012584OtherSTATE OF MICHIGAN