Healthcare Provider Details

I. General information

NPI: 1720689623
Provider Name (Legal Business Name): LAKSHMI DEVI PALUKURI RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W ELM AVE
MONROE MI
48162-7909
US

IV. Provider business mailing address

1063 SHAY ST
CANTON MI
48188-3326
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-3660
  • Fax:
Mailing address:
  • Phone: 408-854-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: