Specialized Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPECIALIZED PHYSICAL THERAPY LLC

Practice address

49783 Annandale Dr
Canton, MI 48187-2159

Phone

(313) 414-1042

NPI assigned

Aug 13, 2020

Last updated

Aug 26, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kishore Jeevanandam, PTNPI 1740578095

Title

Owner

Phone

(313) 414-1042

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kishore Jeevanandam, PT

  • Physical Therapist
  • Livonia, MI
  • NPI 1740578095
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598400000000",
    "number": "1396356176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49783 ANNANDALE DR",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872159",
            "telephone_number": "313-414-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49783 ANNANDALE DR",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481872159",
            "telephone_number": "313-414-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALIZED PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-13",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "JEEVANANDAM",
        "authorized_official_first_name": "KISHORE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-414-1042",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI- IND",
            "identifier": "1740578095",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI- IND",
            "identifier": "1063981421",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "kishorejeva@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "49783 Annandale Dr",
            "city": "Canton",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481872159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kassem Soufan, MD
• Dayse Sousa, OTRL
• Southeastern Michigan Anesthesia
• Gary Stevens Sowpel, PHARMACIST
• Barbara Christine Soyster, MD
• Speech Therapy Solutions of Southeast Michigan PLLC
• Sarah Spencer
• Sue Mary Spencer
• Tracey M Sperry, D.O.
• Amber Lynn Spicer

• Physical Therapist in Canton, MI
• Providers in Canton, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.