Provider Demographics
NPI:1083712475
Name:GADHIYA, GHANSHYAMBHAI K (RPT)
Entity Type:Individual
Prefix:
First Name:GHANSHYAMBHAI
Middle Name:K
Last Name:GADHIYA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:SHAN
Other - Middle Name:K
Other - Last Name:GADHIYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:5511 US WEST 10 HIGHWAY
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:989-560-7591
Mailing Address - Fax:
Practice Address - Street 1:766 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1916
Practice Address - Country:US
Practice Address - Phone:517-796-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist