Provider Demographics
NPI:1861530644
Name:RAJDI, ELIZABETH DIANE (MPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:RAJDI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:33200 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3563
Mailing Address - Country:US
Mailing Address - Phone:248-538-7607
Mailing Address - Fax:248-538-7623
Practice Address - Street 1:33200 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3563
Practice Address - Country:US
Practice Address - Phone:248-538-7607
Practice Address - Fax:248-538-7623
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist