Active NPI
Prasanth Elavarthy
- Physical Therapist
- Jackson, MI
National Provider Identifier
1699094698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501014171
- Practice address
- 3406 Mayapple LN
Apt#21
Jackson, MI 49201-7189 - Phone
- (248) 425-9716
- NPI assigned
- May 31, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501014171 | MI | Primary |
Addresses
Primary practice location
3406 Mayapple LN
Apt#21
Jackson, MI 49201-7189
Mailing address
3406 Mayapple LN
Apt#21
Jackson, MI 49201-7189
Phone (248) 425-9716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501014171 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275264000000",
"number": "1699094698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3406 MAYAPPLE LN",
"address_2": "APT#21",
"city": "JACKSON",
"state": "MI",
"postal_code": "492017189",
"telephone_number": "248-425-9716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3406 MAYAPPLE LN",
"address_2": "APT#21",
"city": "JACKSON",
"state": "MI",
"postal_code": "492017189",
"telephone_number": "248-425-9716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELAVARTHY",
"first_name": "PRASANTH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-31",
"last_updated": "2010-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501014171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.