Provider Demographics
NPI:1750683785
Name:CADELINA, GARY (RPT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CADELINA
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 1:13879 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5446
Mailing Address - Country:US
Mailing Address - Phone:313-729-0111
Mailing Address - Fax:586-566-5828
Practice Address - Street 1:13879 STRATHMORE DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5446
Practice Address - Country:US
Practice Address - Phone:313-729-0111
Practice Address - Fax:586-566-5828
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist