Provider Demographics
NPI:1386741437
Name:AMIN, RAJIV PRAMOD (MPT)
Entity type:Individual
Prefix:MR
First Name:RAJIV
Middle Name:PRAMOD
Last Name:AMIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37699 6 MILE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2695
Mailing Address - Country:US
Mailing Address - Phone:734-953-4155
Mailing Address - Fax:734-953-1622
Practice Address - Street 1:37699 6 MILE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2695
Practice Address - Country:US
Practice Address - Phone:734-953-4155
Practice Address - Fax:734-953-1622
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650H257950OtherBCBS-PHYSICAL THERAPY
MI0N26170OtherMEDICARE PTAN
MI383578878OtherPPOM
MIRA010212Medicare UPIN
MI650H257950OtherBCBS-PHYSICAL THERAPY