Provider Demographics
NPI:1508193228
Name:VENGURLEKAR, RASIKA
Entity Type:Individual
Prefix:
First Name:RASIKA
Middle Name:
Last Name:VENGURLEKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 GOLF VIEW LN
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4747
Mailing Address - Country:US
Mailing Address - Phone:409-201-3596
Mailing Address - Fax:
Practice Address - Street 1:936 GOLF VIEW LN
Practice Address - Street 2:APARTMENT 2
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4747
Practice Address - Country:US
Practice Address - Phone:409-201-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist