Provider Demographics
NPI:1285970400
Name:KANNANPILLAI, NATESAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:NATESAN
Middle Name:
Last Name:KANNANPILLAI
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 1:21415 CIVIC CENTER DR
Mailing Address - Street 2:SUITE # 115
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3909
Mailing Address - Country:US
Mailing Address - Phone:248-327-6266
Mailing Address - Fax:
Practice Address - Street 1:21415 CIVIC CENTER DR
Practice Address - Street 2:SUITE # 115
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3909
Practice Address - Country:US
Practice Address - Phone:248-327-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist