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General NPI Number Information
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NPI Number | 1578702502
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Entity Type | Individual
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Provider Name | RAJESH KUPPUSAMY PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 02/15/2009
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Last Update Date | 02/15/2009
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Provider Practice Location Address
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Address Line | 11293 TERRACE VIEW DR
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-9126
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Country | US
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Telephone | 810-623-9535
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Fax | 810-231-1198
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Provider Business Mailing Address
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Address Line | 11293 TERRACE VIEW DR
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-9126
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Country | US
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Telephone | 810-623-9535
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Fax | 810-231-1198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5501008776
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License Number State | MI
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