Provider Demographics
NPI:1285134155
Name:NAIR, SANTHOSH KRISHNANKUTTY (RPT)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:KRISHNANKUTTY
Last Name:NAIR
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 1:51562 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3861
Mailing Address - Country:US
Mailing Address - Phone:586-219-5534
Mailing Address - Fax:
Practice Address - Street 1:51562 MERRY LN
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316-3861
Practice Address - Country:US
Practice Address - Phone:586-219-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist