Healthcare Provider Details

I. General information

NPI: 1346385309
Provider Name (Legal Business Name): ANJALI S GADKARI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20153 RODEO CT
SOUTHFIELD MI
48075-1281
US

IV. Provider business mailing address

20153 RODEO CT
SOUTHFIELD MI
48075-1281
US

V. Phone/Fax

Practice location:
  • Phone: 248-358-9099
  • Fax:
Mailing address:
  • Phone: 248-358-9099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number5501011786
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011786
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5501011786
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501011786
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number5501011786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: