Provider Demographics
NPI:1306048210
Name:SOUTHEAST REHABILITATION AND PHYSICAL THERAPY INC.
Entity type:Organization
Organization Name:SOUTHEAST REHABILITATION AND PHYSICAL THERAPY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MHS
Authorized Official - Phone:248-945-9905
Mailing Address - Street 1:26771 W 12 MILE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1539
Mailing Address - Country:US
Mailing Address - Phone:248-945-9905
Mailing Address - Fax:248-945-9906
Practice Address - Street 1:26771 W 12 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1539
Practice Address - Country:US
Practice Address - Phone:248-945-9905
Practice Address - Fax:248-945-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty