Provider Demographics
NPI:1376552786
Name:GORADIA, NINA (PT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:GORADIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 E 116TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1534
Mailing Address - Country:US
Mailing Address - Phone:317-813-2100
Mailing Address - Fax:
Practice Address - Street 1:8235 E 116TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1534
Practice Address - Country:US
Practice Address - Phone:317-813-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29783225100000X
IN05007913A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist