Provider Demographics
NPI:1073864633
Name:WACHOWIAK, MICHAEL ALAN (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:WACHOWIAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:33481 W 14 MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1578
Practice Address - Country:US
Practice Address - Phone:248-661-6708
Practice Address - Fax:248-661-8051
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501006603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist