Provider Demographics
NPI:1396446910
Name:SUNRISE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SUNRISE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDIPKUMAR
Authorized Official - Middle Name:ISHWARLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-412-3450
Mailing Address - Street 1:1721 OSPREY POINT CIR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2158
Mailing Address - Country:US
Mailing Address - Phone:248-412-3450
Mailing Address - Fax:
Practice Address - Street 1:594 S COLUMBIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9095
Practice Address - Country:US
Practice Address - Phone:248-412-3450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty