Provider Demographics
NPI:1861559718
Name:RAMAWICKRAMA, SUNEETHA RENU (PT, GCFP)
Entity type:Individual
Prefix:MRS
First Name:SUNEETHA
Middle Name:RENU
Last Name:RAMAWICKRAMA
Suffix:
Gender:F
Credentials:PT, GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 HILLSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4287
Mailing Address - Country:US
Mailing Address - Phone:248-844-8104
Mailing Address - Fax:248-852-4937
Practice Address - Street 1:977 HILLSBOROUGH DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4287
Practice Address - Country:US
Practice Address - Phone:248-844-8104
Practice Address - Fax:248-852-4937
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P29150Medicare PIN