Provider Demographics
NPI:1205269792
Name:MODI, NIDHI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42621 GARFIELD RD
Mailing Address - Street 2:102
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5031
Mailing Address - Country:US
Mailing Address - Phone:586-838-2444
Mailing Address - Fax:586-838-2442
Practice Address - Street 1:42621 GARFIELD RD
Practice Address - Street 2:102
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5031
Practice Address - Country:US
Practice Address - Phone:586-838-2444
Practice Address - Fax:586-838-2442
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist