Provider Demographics
NPI:1730463878
Name:BHAGAT, RADHIKA ANIRUDH (PT)
Entity Type:Individual
Prefix:MRS
First Name:RADHIKA
Middle Name:ANIRUDH
Last Name:BHAGAT
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 1:653 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118
Mailing Address - Country:US
Mailing Address - Phone:313-570-5291
Mailing Address - Fax:
Practice Address - Street 1:7200 DAN HOEY RD
Practice Address - Street 2:STE F2
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-4201
Practice Address - Country:US
Practice Address - Phone:313-570-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8096225100000X
MI5501012045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist