Provider Demographics
NPI:1487316501
Name:ALDRIDGE, KATRINA (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27247 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1022
Mailing Address - Country:US
Mailing Address - Phone:313-638-1542
Mailing Address - Fax:313-638-1559
Practice Address - Street 1:27247 JOY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1022
Practice Address - Country:US
Practice Address - Phone:313-638-1542
Practice Address - Fax:313-638-1559
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI75010029982081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine