Provider Demographics
NPI:1104915610
Name:PATEL, SHRADHDHEY K (BPT/RPT)
Entity type:Individual
Prefix:MR
First Name:SHRADHDHEY
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:BPT/RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-560-7591
Mailing Address - Fax:
Practice Address - Street 1:5511 W US HIGHWAY 10
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2455
Practice Address - Country:US
Practice Address - Phone:989-560-7591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist