Provider Demographics
NPI:1164743027
Name:BANDI, RANJITH KUMAR (PT)
Entity Type:Individual
Prefix:
First Name:RANJITH KUMAR
Middle Name:
Last Name:BANDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31550 HARLO DR
Mailing Address - Street 2:APT H
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1977
Mailing Address - Country:US
Mailing Address - Phone:917-607-9723
Mailing Address - Fax:
Practice Address - Street 1:31550 HARLO DR
Practice Address - Street 2:APT H
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1977
Practice Address - Country:US
Practice Address - Phone:917-607-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015013OtherSTATE OF MICHIGAN