Provider Demographics
NPI:1477707230
Name:WOZNIAK, STACY THERESE
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:THERESE
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:THERESE
Other - Last Name:MAKINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3145 W CLARK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1197
Mailing Address - Country:US
Mailing Address - Phone:734-528-9760
Mailing Address - Fax:734-829-0173
Practice Address - Street 1:3145 W CLARK RD STE 102
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1120
Practice Address - Country:US
Practice Address - Phone:734-528-9760
Practice Address - Fax:734-829-0173
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist