Provider Demographics
NPI:1629701289
Name:SURESH, AKHILA
Entity Type:Individual
Prefix:MS
First Name:AKHILA
Middle Name:
Last Name:SURESH
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 1:44 PRIMROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAULT STE MARIE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:P6B4E6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WAR MEMORIAL REHABILITATION CENTER
Practice Address - Street 2:2427 ASHMUN STREET
Practice Address - City:SAULT STE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783
Practice Address - Country:US
Practice Address - Phone:906-635-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty