Provider Demographics
NPI:1174041479
Name:GULATI, ALKA (PT)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:
Last Name:GULATI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18055 STONEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4345
Mailing Address - Country:US
Mailing Address - Phone:487-735-0692
Mailing Address - Fax:
Practice Address - Street 1:15132 LEVAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-968-9206
Practice Address - Fax:734-462-1744
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM408642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM408642OtherSTATE LICENSE BOARD