| Organization Name: | RIDE4FUN BRIDGEWATER FARMS |
| NPI Number: | 1144408923 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NEEL N. SHETH (PRESIDENT OF THE BOARD) |
| Mailing Address: | 8957 Austin Rd Saline |
| State: | MI US |
| Postal Code: | 481769686 |
| Phone Number: | 7349446651 |
| Fax Number: | 7349446651 |
| NPI Enumeration Date: | 02/05/2008 |
| NPI Last Update Date: | 02/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 5501003428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |