Provider Demographics
NPI:1417058512
Name:WESOLOWSKI, BARBARA ANTONIA (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANTONIA
Last Name:WESOLOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:ANTONIA
Other - Last Name:TEODORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9880 NAVY PIER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-8262
Mailing Address - Country:US
Mailing Address - Phone:269-779-3842
Mailing Address - Fax:
Practice Address - Street 1:9880 NAVY PIER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-8262
Practice Address - Country:US
Practice Address - Phone:269-779-3842
Practice Address - Fax:269-585-6319
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55001015667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist