Provider Demographics
NPI:1679789283
Name:AHLUWALIA, SMITA (RPT)
Entity type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:AHLUWALIA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3216
Mailing Address - Country:US
Mailing Address - Phone:248-582-9903
Mailing Address - Fax:248-582-9907
Practice Address - Street 1:204 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3216
Practice Address - Country:US
Practice Address - Phone:248-582-9903
Practice Address - Fax:248-582-9907
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501005394OtherPT LICENSE