Provider Demographics
NPI:1053500173
Name:BRODITH, ANEMAECORE ABADEJOS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:ANEMAECORE
Middle Name:ABADEJOS
Last Name:BRODITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:23240 WESTBURY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2549
Mailing Address - Country:US
Mailing Address - Phone:313-478-1182
Mailing Address - Fax:
Practice Address - Street 1:26000 HOOVER RD STE 101
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-381-8141
Practice Address - Fax:586-393-1733
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004528225100000X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist