Provider Demographics
NPI:1790150365
Name:TRADA, NILESHKUMAR VALLABHBHAI (PT)
Entity Type:Individual
Prefix:
First Name:NILESHKUMAR
Middle Name:VALLABHBHAI
Last Name:TRADA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:NILESH
Other - Middle Name:
Other - Last Name:TRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:9539 INDIAN BEECH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3573
Mailing Address - Country:US
Mailing Address - Phone:989-551-8804
Mailing Address - Fax:
Practice Address - Street 1:9539 INDIAN BEECH AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3573
Practice Address - Country:US
Practice Address - Phone:989-551-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017141225100000X
NCP-16041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501017141OtherPHYSICAL THERAPIST LICENSE NUMBER
NCP-16041OtherPHYSICAL THERAPIST LICENSE NUMBER