MEDICARE: SUDESHNA DANU RPT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501007669	MI

General Provider Information

NPI Number	:	1053347252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDESHNA DANU RPT, DPT

Provider Business Mailing Address
First Line	:	7800 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3461
Country	:	US
Telephone Number	:	313-543-6295
Fax Number	:	313-543-6275

Provider Business Practice Location Address
First Line	:	7800 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3461
Country	:	US
Telephone Number	:	313-543-6295
Fax Number	:	313-543-6275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/17/2021

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