Provider Demographics
NPI:1023181179
Name:PODLEWSKI, ADRIA M (MPT)
Entity Type:Individual
Prefix:MS
First Name:ADRIA
Middle Name:M
Last Name:PODLEWSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29500 RYAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2292
Mailing Address - Country:US
Mailing Address - Phone:586-574-2425
Mailing Address - Fax:586-574-2443
Practice Address - Street 1:29500 RYAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2292
Practice Address - Country:US
Practice Address - Phone:586-574-2425
Practice Address - Fax:586-574-2443
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501005814OtherPT LICENSE NUMBER
MIP37600001Medicare UPIN
MI0P37600Medicare PIN