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General NPI Number Information
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NPI Number | 1952804569
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Entity Type | Individual
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Provider Name | VICTOR ABADEJOS BRODITH DPT
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Gender | Male
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Dates
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Enumeration Date | 03/10/2018
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Last Update Date | 03/10/2018
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-1128
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Fax |
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Provider Business Mailing Address
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Address Line | 20507 EDMUNTON ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017609
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License Number State | MI
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