Provider Demographics
NPI:1144408923
Name:RIDE4FUN BRIDGEWATER FARMS
Entity type:Organization
Organization Name:RIDE4FUN BRIDGEWATER FARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-944-6651
Mailing Address - Street 1:8957 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9686
Mailing Address - Country:US
Mailing Address - Phone:734-944-6651
Mailing Address - Fax:734-944-6651
Practice Address - Street 1:8957 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9686
Practice Address - Country:US
Practice Address - Phone:734-944-6651
Practice Address - Fax:734-944-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003428261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy