Provider Demographics
NPI:1447620513
Name:TRADA, PINKY (RPT)
Entity type:Individual
Prefix:
First Name:PINKY
Middle Name:
Last Name:TRADA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:PINKY
Other - Middle Name:BIPINCHANDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:507 N PORT CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-1208
Mailing Address - Country:US
Mailing Address - Phone:989-551-8804
Mailing Address - Fax:
Practice Address - Street 1:507 N PORT CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1208
Practice Address - Country:US
Practice Address - Phone:989-551-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014281OtherSTATE OF MICHIGAN, DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS