Provider Demographics
NPI:1417409129
Name:SPADARO, AUDRIANA (PT)
Entity Type:Individual
Prefix:
First Name:AUDRIANA
Middle Name:
Last Name:SPADARO
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 1:29700 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2012
Mailing Address - Country:US
Mailing Address - Phone:810-449-7438
Mailing Address - Fax:
Practice Address - Street 1:6530 FARMINGTON RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3216
Practice Address - Country:US
Practice Address - Phone:248-451-6010
Practice Address - Fax:248-451-6019
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist