Jayasundera, Victor

Jayasundera, Victor is an individual health care provider with primary practice located at 23100 Providence Dr Suite 135, Southfield MI 48075-3646. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Jayasundera, Victor can be contacted via phone (248) 905-5180.

Contact Information

Primary practice address
23100 Providence Dr Suite 135 Southfield MI 48075-3646
Phone: (248) 905-5180
Fax: (248) 905-5181
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 5501005927 Michigan

Profile Details

NPI number 1558488783
LBN Legal business name Jayasundera, Victor
Credentials Registered Physical Therapist (RPT)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2007
Last updated Jan 26th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558488783 NPPES
Michigan Other 5501005927 STATE LICENSE

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