Provider Demographics
NPI:1528227170
Name:DISSANAYAKE, HAPUWITA R (PT)
Entity Type:Individual
Prefix:
First Name:HAPUWITA
Middle Name:R
Last Name:DISSANAYAKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33278 TALL OAKS CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-4548
Mailing Address - Country:US
Mailing Address - Phone:248-579-3610
Mailing Address - Fax:248-442-8520
Practice Address - Street 1:21005 FARMINGTON RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5083
Practice Address - Country:US
Practice Address - Phone:248-579-3610
Practice Address - Fax:248-442-8520
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist