MEDICARE: RS PHYSICAL THERAPY INC

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	5501007788	MI

General Provider Information

NPI Number	:	1386608131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RS PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1123 E WEST MAPLE RD
Second Line	:	SUITE 2
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3700
Country	:	US
Telephone Number	:	248-960-2334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1123 E WEST MAPLE RD
Second Line	:	SUITE 2
City	:	WALLED LAKE
State	:	MI
Zip	:	48390-3700
Country	:	US
Telephone Number	:	248-960-2334
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHEELA PREMKUMAR
Credential	:	BS PT
Telephone Number	:	248-960-2334

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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