Healthcare Provider Details

I. General information

NPI: 1386608131
Provider Name (Legal Business Name): RS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 E WEST MAPLE RD SUITE 2
WALLED LAKE MI
48390-3700
US

IV. Provider business mailing address

1123 E WEST MAPLE RD SUITE 2
WALLED LAKE MI
48390-3700
US

V. Phone/Fax

Practice location:
  • Phone: 248-960-2334
  • Fax:
Mailing address:
  • Phone: 248-960-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007788
License Number StateMI

VIII. Authorized Official

Name: SHEELA PREMKUMAR
Title or Position: PRESIDENT
Credential: BS PT
Phone: 248-960-2334