Provider Demographics
NPI:1962713784
Name:PRASAD, RINKU (RPT)
Entity type:Individual
Prefix:
First Name:RINKU
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-772-7755
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:4150 225TH AVE
Practice Address - Street 2:SUITE # C
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-7918
Practice Address - Country:US
Practice Address - Phone:989-772-7755
Practice Address - Fax:989-772-7750
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501014965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014965OtherSTATE OF MI