Provider Demographics
NPI:1346767613
Name:PULIYAKOTE, AMBIKA KUNNATH (RPT)
Entity Type:Individual
Prefix:MS
First Name:AMBIKA
Middle Name:KUNNATH
Last Name:PULIYAKOTE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17187 N LAUREL PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2692
Mailing Address - Country:US
Mailing Address - Phone:734-402-1073
Mailing Address - Fax:
Practice Address - Street 1:5570 WHITTAKER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9752
Practice Address - Country:US
Practice Address - Phone:734-482-1200
Practice Address - Fax:734-402-1074
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist