Provider Demographics
NPI:1235795337
Name:PAPA, DOREEN DOPLAYNA
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:DOPLAYNA
Last Name:PAPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30595 BERGHWAY TRL
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-6334
Mailing Address - Country:US
Mailing Address - Phone:586-383-0246
Mailing Address - Fax:
Practice Address - Street 1:3999 VENOY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1485
Practice Address - Country:US
Practice Address - Phone:734-727-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist