Provider Demographics
NPI:1508368143
Name:SHANMUGAM, SATHEESH KUMAR (PT)
Entity Type:Individual
Prefix:MR
First Name:SATHEESH KUMAR
Middle Name:
Last Name:SHANMUGAM
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 1:4111 S CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2489
Mailing Address - Country:US
Mailing Address - Phone:734-397-0496
Mailing Address - Fax:
Practice Address - Street 1:4111 S CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2489
Practice Address - Country:US
Practice Address - Phone:734-397-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist