Provider Demographics
NPI:1760552400
Name:KARUNANAYAKE, ROHAN (PT)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:KARUNANAYAKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40030 CARINI DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5373
Mailing Address - Country:US
Mailing Address - Phone:586-566-5178
Mailing Address - Fax:
Practice Address - Street 1:127 W AUBURN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5002
Practice Address - Country:US
Practice Address - Phone:248-844-8248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP22060001Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER