Provider Demographics
NPI:1215399563
Name:FISZER-DOBROWOLSKA, PATRYCJA
Entity Type:Individual
Prefix:
First Name:PATRYCJA
Middle Name:
Last Name:FISZER-DOBROWOLSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LEGACY PARK DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1351
Mailing Address - Country:US
Mailing Address - Phone:484-650-0556
Mailing Address - Fax:
Practice Address - Street 1:2530 MARFITT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6343
Practice Address - Country:US
Practice Address - Phone:517-318-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant