Provider Demographics
NPI:1477725356
Name:HERATH, CHINTHANA (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHINTHANA
Middle Name:
Last Name:HERATH
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:HERATH
Other - Middle Name:
Other - Last Name:HERATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:23719 CORA AVENUE.
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336
Mailing Address - Country:US
Mailing Address - Phone:248-302-3601
Mailing Address - Fax:
Practice Address - Street 1:23719 CORA AVENUE.
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-302-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist