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Organization
MI SPORTS REHAB P.C
Active
Organization
MI SPORTS REHAB P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINOTH S PURUSOTHAMAN PT, DPT (PRESIDENT)
(248) 208-7492
Entity
Organization
Contact information
Practice address
25865 W 12 MILE RD, SUITE 104, SOUTHFIELD, MI 48034-1817
(248) 208-7492
(248) 208-7494
Mailing address
25865 W 12 MILE RD, SUITE 104, SOUTHFIELD, MI 48034-1817
(248) 208-7492
(248) 208-7494
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5501006095
MI
225100000X
Physical Therapist
Primary
5501006291
MI
225100000X
Physical Therapist
5501006612
MI
225X00000X
Occupational Therapist
5201000744
MI
235Z00000X
Speech-Language Pathologist
12080163
MI
Other
Enumeration date
03/23/2012
Last updated
03/23/2012
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