Provider Demographics
NPI:1316920812
Name:OPPAT, BRAD RICHARD (PT)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:RICHARD
Last Name:OPPAT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28634 LINCOLNVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5250
Mailing Address - Country:US
Mailing Address - Phone:248-227-9812
Mailing Address - Fax:
Practice Address - Street 1:6343 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2206
Practice Address - Country:US
Practice Address - Phone:482-227-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006622225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4726110Medicaid
MIP00147335OtherMEDICARE RAILROAD
MI650F358460OtherBLUE CROSS BLUE SHIELD
MI650F358460OtherBLUE CROSS BLUE SHIELD