Provider Demographics
NPI:1538471016
Name:NAGLE, NAYANA SHASHIKANT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NAYANA
Middle Name:SHASHIKANT
Last Name:NAGLE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1740 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1740 W BIG BEAVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3507
Practice Address - Country:US
Practice Address - Phone:248-885-8302
Practice Address - Fax:248-885-8347
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501002291L1580953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3963Medicare PIN