Provider Demographics
NPI:1740542091
Name:HANDA, RAHUL R
Entity type:Individual
Prefix:
First Name:RAHUL
Middle Name:R
Last Name:HANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31132 MORLOCK ST
Mailing Address - Street 2:614
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1647
Mailing Address - Country:US
Mailing Address - Phone:586-873-3989
Mailing Address - Fax:248-404-6902
Practice Address - Street 1:31132 MORLOCK ST
Practice Address - Street 2:614
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1647
Practice Address - Country:US
Practice Address - Phone:586-873-3989
Practice Address - Fax:248-404-6902
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist