Provider Demographics
NPI:1821638131
Name:NALIATH, SANDEEP RAJ (PT)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:RAJ
Last Name:NALIATH
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 1:42596 PLUM LN
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2947
Mailing Address - Country:US
Mailing Address - Phone:586-344-1816
Mailing Address - Fax:
Practice Address - Street 1:1883 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4207
Practice Address - Country:US
Practice Address - Phone:248-588-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist