Provider Demographics
NPI:1194845792
Name:MURUGAN, MUTHUVINAYAGAM (RPT)
Entity type:Individual
Prefix:
First Name:MUTHUVINAYAGAM
Middle Name:
Last Name:MURUGAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 OAK MOSS CT
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3865
Mailing Address - Country:US
Mailing Address - Phone:810-385-9366
Mailing Address - Fax:
Practice Address - Street 1:3403 LAPEER RD STE B101
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3013
Practice Address - Country:US
Practice Address - Phone:810-984-4131
Practice Address - Fax:810-984-1612
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist