Provider Demographics
NPI:1164757647
Name:MODI, SUCHI R (RPT)
Entity Type:Individual
Prefix:MISS
First Name:SUCHI
Middle Name:R
Last Name:MODI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17070 W 12 MILE RD STE E
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2116
Mailing Address - Country:US
Mailing Address - Phone:248-483-3990
Mailing Address - Fax:248-750-0692
Practice Address - Street 1:17070 W 12 MILE RD
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2116
Practice Address - Country:US
Practice Address - Phone:248-483-3990
Practice Address - Fax:248-750-0692
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014492OtherSTATE OF MICHIGAN