Provider Demographics
NPI:1790132272
Name:SUKHADIA, DHARA
Entity Type:Individual
Prefix:
First Name:DHARA
Middle Name:
Last Name:SUKHADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37198 MANCHESTER DR
Mailing Address - Street 2:APT 46
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2360
Mailing Address - Country:US
Mailing Address - Phone:734-639-0594
Mailing Address - Fax:
Practice Address - Street 1:38777 6 MILE RD # MI
Practice Address - Street 2:SUITE 209
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2694
Practice Address - Country:US
Practice Address - Phone:888-414-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist