Healthcare Provider Details

I. General information

NPI: 1396446910
Provider Name (Legal Business Name): SUNRISE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 S COLUMBIA AVE STE 100
RINCON GA
31326-9095
US

IV. Provider business mailing address

1721 OSPREY POINT CIR
POOLER GA
31322-2158
US

V. Phone/Fax

Practice location:
  • Phone: 248-412-3450
  • Fax:
Mailing address:
  • Phone: 248-412-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDIPKUMAR ISHWARLAL PATEL
Title or Position: OWNER
Credential:
Phone: 248-412-3450