Provider Demographics
NPI:1275523078
Name:PREM, SHEELA (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHEELA
Middle Name:
Last Name:PREM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45023 W PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1255
Mailing Address - Country:US
Mailing Address - Phone:248-960-2334
Mailing Address - Fax:
Practice Address - Street 1:45023 W PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1255
Practice Address - Country:US
Practice Address - Phone:248-960-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist