Provider Demographics
NPI:1447296314
Name:BARADIA, MANJU (PT)
Entity type:Individual
Prefix:MRS
First Name:MANJU
Middle Name:
Last Name:BARADIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5862 FINEWAY CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1383
Mailing Address - Country:US
Mailing Address - Phone:616-604-0565
Mailing Address - Fax:616-604-1921
Practice Address - Street 1:5862 FINEWAY CT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1383
Practice Address - Country:US
Practice Address - Phone:616-604-0565
Practice Address - Fax:616-604-1921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2204222382034Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER