Provider Demographics
NPI:1578702502
Name:KUPPUSAMY, RAJESH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:KUPPUSAMY
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11293 TERRACE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9126
Mailing Address - Country:US
Mailing Address - Phone:810-623-9535
Mailing Address - Fax:810-231-1198
Practice Address - Street 1:11293 TERRACE VIEW DR
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9126
Practice Address - Country:US
Practice Address - Phone:810-623-9535
Practice Address - Fax:810-231-1198
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist