Provider Demographics
NPI:1386608131
Name:RS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PREMKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:BS PT
Authorized Official - Phone:248-960-2334
Mailing Address - Street 1:1123 E WEST MAPLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3700
Mailing Address - Country:US
Mailing Address - Phone:248-960-2334
Mailing Address - Fax:
Practice Address - Street 1:1123 E WEST MAPLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3700
Practice Address - Country:US
Practice Address - Phone:248-960-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26820Medicare ID - Type UnspecifiedOUT PATIENT REHAB