Provider Demographics
NPI:1487134748
Name:KADAM, SHRADDHA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MISS
First Name:SHRADDHA
Middle Name:
Last Name:KADAM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E CANYON GROVE RD APT 534
Mailing Address - Street 2:
Mailing Address - City:KNOLLWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3942
Mailing Address - Country:US
Mailing Address - Phone:908-528-4945
Mailing Address - Fax:
Practice Address - Street 1:1101 REBA MACENTIRE LN
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-9059
Practice Address - Country:US
Practice Address - Phone:903-463-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1269197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist