Provider Demographics
NPI:1316251440
Name:SENEVIRATNE, GOTHAMIE UDAYAKANTHI
Entity type:Individual
Prefix:
First Name:GOTHAMIE
Middle Name:UDAYAKANTHI
Last Name:SENEVIRATNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19220 FLAMINGO BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1709
Mailing Address - Country:US
Mailing Address - Phone:248-474-4439
Mailing Address - Fax:
Practice Address - Street 1:8380 GEDDES RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9404
Practice Address - Country:US
Practice Address - Phone:734-547-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1821646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist