Provider Demographics
NPI:1639670219
Name:SADASIVAM, KALAISELVI
Entity Type:Individual
Prefix:
First Name:KALAISELVI
Middle Name:
Last Name:SADASIVAM
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 1:7800 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3461
Mailing Address - Country:US
Mailing Address - Phone:313-543-6295
Mailing Address - Fax:313-543-6275
Practice Address - Street 1:7800 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3461
Practice Address - Country:US
Practice Address - Phone:313-543-6295
Practice Address - Fax:313-543-6275
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist