Provider Demographics
NPI:1497069728
Name:RATHOD, JAYADEEPSINH RAJENDRASINH (RPT)
Entity Type:Individual
Prefix:MR
First Name:JAYADEEPSINH
Middle Name:RAJENDRASINH
Last Name:RATHOD
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43973 NOWLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188
Mailing Address - Country:US
Mailing Address - Phone:248-304-1900
Mailing Address - Fax:989-772-7750
Practice Address - Street 1:43973 NOWLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188
Practice Address - Country:US
Practice Address - Phone:248-304-1900
Practice Address - Fax:989-772-7750
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013850OtherSTATE OF MICHIGAN