Provider Demographics
NPI:1841049616
Name:MEEGAMA SEMBAKUTTI, PRADEEP KUMARA
Entity type:Individual
Prefix:MR
First Name:PRADEEP
Middle Name:KUMARA
Last Name:MEEGAMA SEMBAKUTTI
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 1:30990 STONE RIDGE DR APT 10106
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3898
Mailing Address - Country:US
Mailing Address - Phone:313-980-2260
Mailing Address - Fax:
Practice Address - Street 1:31904 RYAN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1339
Practice Address - Country:US
Practice Address - Phone:586-344-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist