Healthcare Provider Details

I. General information

NPI: 1568596252
Provider Name (Legal Business Name): SWETA DEY RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 AXTELL DR #8
TROY MI
48084-4405
US

IV. Provider business mailing address

1890 AXTELL DR #8
TROY MI
48084-4405
US

V. Phone/Fax

Practice location:
  • Phone: 248-470-6220
  • Fax:
Mailing address:
  • Phone: 248-470-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1037788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: