Provider Demographics
NPI:1205178001
Name:HEWAGE, GUNASINGHE P (PT)
Entity Type:Individual
Prefix:
First Name:GUNASINGHE
Middle Name:P
Last Name:HEWAGE
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 1:25740 ARDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1622
Mailing Address - Country:US
Mailing Address - Phone:313-822-4220
Mailing Address - Fax:313-822-4220
Practice Address - Street 1:25740 ARDEN PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1622
Practice Address - Country:US
Practice Address - Phone:313-822-4220
Practice Address - Fax:313-822-4220
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist