Provider Demographics
NPI:1306980735
Name:ARORA, GAUTAM (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GAUTAM
Middle Name:
Last Name:ARORA
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 1:4265 ARLET CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8276
Mailing Address - Country:US
Mailing Address - Phone:616-285-9261
Mailing Address - Fax:
Practice Address - Street 1:2920 FULLER AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3458
Practice Address - Country:US
Practice Address - Phone:616-361-8355
Practice Address - Fax:616-361-8354
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02280Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER