Provider Demographics
NPI:1912021502
Name:DOGRA, KULDEEP (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:KULDEEP
Middle Name:
Last Name:DOGRA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 SOREL DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1295
Mailing Address - Country:US
Mailing Address - Phone:734-397-9172
Mailing Address - Fax:734-331-2785
Practice Address - Street 1:632 SOREL DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1295
Practice Address - Country:US
Practice Address - Phone:734-397-9172
Practice Address - Fax:734-331-2785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N89610Medicare ID - Type UnspecifiedPHYSICAL THERAPIST