Provider Demographics
NPI:1609186592
Name:SZOSTAKOWSKI, LISA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SZOSTAKOWSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30020 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3125
Mailing Address - Country:US
Mailing Address - Phone:586-775-5267
Mailing Address - Fax:586-775-2331
Practice Address - Street 1:30020 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3125
Practice Address - Country:US
Practice Address - Phone:586-775-5267
Practice Address - Fax:586-775-2331
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist