Provider Demographics
NPI:1184165110
Name:GORADIA, DIPIKA
Entity type:Individual
Prefix:
First Name:DIPIKA
Middle Name:
Last Name:GORADIA
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 1:21102 BARTON HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6416
Mailing Address - Country:US
Mailing Address - Phone:832-215-4747
Mailing Address - Fax:832-945-2100
Practice Address - Street 1:21102 BARTON HOLLOW LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-6416
Practice Address - Country:US
Practice Address - Phone:832-215-4747
Practice Address - Fax:832-945-2100
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1028801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist