Provider Demographics
NPI:1104397652
Name:RADOSA, ARON JOSEPH
Entity Type:Individual
Prefix:
First Name:ARON
Middle Name:JOSEPH
Last Name:RADOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6831
Mailing Address - Country:US
Mailing Address - Phone:989-781-3150
Mailing Address - Fax:
Practice Address - Street 1:915 N RIVER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-6831
Practice Address - Country:US
Practice Address - Phone:989-781-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist