Provider Demographics
NPI:1548595598
Name:MALISKEY, LOLITA MARIA
Entity Type:Individual
Prefix:PROF
First Name:LOLITA
Middle Name:MARIA
Last Name:MALISKEY
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 1:24725 W 12 MILE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1801
Mailing Address - Country:US
Mailing Address - Phone:888-686-4300
Mailing Address - Fax:248-350-8919
Practice Address - Street 1:24725 W 12 MILE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1801
Practice Address - Country:US
Practice Address - Phone:888-686-4300
Practice Address - Fax:248-350-8919
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist