Provider Demographics
NPI:1407496300
Name:OPRISIU, DUSTIN (CPT)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:OPRISIU
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44560 BAYVIEW AVE APT 26305
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7355
Mailing Address - Country:US
Mailing Address - Phone:248-821-8433
Mailing Address - Fax:
Practice Address - Street 1:3058 N STATE RD STE E
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-3508
Practice Address - Country:US
Practice Address - Phone:810-652-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIT1914542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer