Provider Demographics
NPI:1053347252
Name:DANU, SUDESHNA (RPT, DPT)
Entity type:Individual
Prefix:
First Name:SUDESHNA
Middle Name:
Last Name:DANU
Suffix:
Gender:F
Credentials:RPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3461
Mailing Address - Country:US
Mailing Address - Phone:313-543-6295
Mailing Address - Fax:313-543-6275
Practice Address - Street 1:7800 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3461
Practice Address - Country:US
Practice Address - Phone:313-543-6295
Practice Address - Fax:313-543-6275
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00650003Medicare UPIN