Provider Demographics
NPI:1568932325
Name:LALA, PRATIBHA (MPT)
Entity Type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:
Last Name:LALA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:PRATIBHA
Other - Middle Name:
Other - Last Name:MISHRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1663 STEPHENSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2169
Mailing Address - Country:US
Mailing Address - Phone:248-327-6619
Mailing Address - Fax:
Practice Address - Street 1:1663 STEPHENSON HWY
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2169
Practice Address - Country:US
Practice Address - Phone:248-327-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037546225100000X
MI5501017155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist