Provider Demographics
NPI:1720367675
Name:BHAGWAT, RUMA RAGHAV (PT)
Entity Type:Individual
Prefix:
First Name:RUMA
Middle Name:RAGHAV
Last Name:BHAGWAT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33497 23 MILE RD
Mailing Address - Street 2:STE 170
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4062
Mailing Address - Country:US
Mailing Address - Phone:586-716-1278
Mailing Address - Fax:586-716-1282
Practice Address - Street 1:33497 23 MILE RD
Practice Address - Street 2:STE 170
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4062
Practice Address - Country:US
Practice Address - Phone:586-716-1278
Practice Address - Fax:586-716-1282
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist