Organization
ELITE PHYSICAL THERAPY OF SOUTHFIELD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJA GOVINDARAJALU R.P.T. (OWNER)
(248) 722-1156
Entity
Organization
Contact information
Practice address
15565 NORTHLAND DR E STE 816, SOUTHFIELD, MI 48075-5329
(248) 722-1156
Mailing address
15565 NORTHLAND DR E STE 816, SOUTHFIELD, MI 48075-5329
(248) 722-1156
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
10/01/2020
Last updated
10/01/2020
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