Provider Demographics
NPI:1639455710
Name:DAVOODIARIA, NIKKI (DPT)
Entity Type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:
Last Name:DAVOODIARIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 177
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4514
Mailing Address - Country:US
Mailing Address - Phone:248-647-1470
Mailing Address - Fax:248-647-1472
Practice Address - Street 1:30100 TELEGRAPH RD
Practice Address - Street 2:SUITE 177
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4514
Practice Address - Country:US
Practice Address - Phone:248-647-1470
Practice Address - Fax:248-647-1472
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist