Provider Demographics
NPI:1841495389
Name:ARIDIDON, MINERVA TERO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:TERO
Last Name:ARIDIDON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47085 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2761
Mailing Address - Country:US
Mailing Address - Phone:586-598-1247
Mailing Address - Fax:586-598-1260
Practice Address - Street 1:47085 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2761
Practice Address - Country:US
Practice Address - Phone:586-598-1247
Practice Address - Fax:586-598-1260
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-F3-3358-0OtherBCBSM
MI65-0-F3-3358-0OtherBCBSM