Provider Demographics
NPI:1114288149
Name:MAKADIA, STUTI P (RPT)
Entity Type:Individual
Prefix:MRS
First Name:STUTI
Middle Name:P
Last Name:MAKADIA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 KARNELL DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5747
Mailing Address - Country:US
Mailing Address - Phone:732-878-0624
Mailing Address - Fax:
Practice Address - Street 1:2114 OAK TREE RD STE A
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1404
Practice Address - Country:US
Practice Address - Phone:732-494-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01440700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist