Provider Demographics
NPI:1376846832
Name:PANDYA, NEHA HASMUKHLAL (RPT)
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:HASMUKHLAL
Last Name:PANDYA
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 1:2117 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3553
Mailing Address - Country:US
Mailing Address - Phone:586-573-4684
Mailing Address - Fax:586-573-2575
Practice Address - Street 1:2117 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3553
Practice Address - Country:US
Practice Address - Phone:586-573-4684
Practice Address - Fax:586-573-2575
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501015275OtherSTATE OF MICHIGAN