Provider Demographics
NPI:1982765269
Name:SARDEY, DEEPAK A (PT)
Entity Type:Individual
Prefix:MR
First Name:DEEPAK
Middle Name:A
Last Name:SARDEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 LOUIS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5038
Mailing Address - Country:US
Mailing Address - Phone:586-677-5574
Mailing Address - Fax:
Practice Address - Street 1:54750 MOUND RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-1706
Practice Address - Country:US
Practice Address - Phone:586-677-5574
Practice Address - Fax:586-677-5578
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010058682251G0304X, 2251N0400X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650E05729OtherBCBS OF MICHIGAN
MI4157105Medicaid
MI4157105Medicaid