1407932866 NPI number — EMILY ELIZABETH RADE PT

Table of content: EMILY ELIZABETH RADE PT (NPI 1407932866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407932866 NPI number — EMILY ELIZABETH RADE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADE
Provider First Name:
EMILY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407932866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 SOUTH HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 16
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-533-7401
Provider Business Mailing Address Fax Number:
954-990-4720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 SOUTH HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-533-7401
Provider Business Practice Location Address Fax Number:
954-990-4720
Provider Enumeration Date:
10/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  023426-1 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1779725 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".