Provider Demographics
NPI:1659540680
Name:WEDEL, CLIFFORD JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JOSEPH
Last Name:WEDEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E REID RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8835
Mailing Address - Country:US
Mailing Address - Phone:810-515-4052
Mailing Address - Fax:810-694-3855
Practice Address - Street 1:3375 N LINDEN RD
Practice Address - Street 2:#515
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-5719
Practice Address - Country:US
Practice Address - Phone:810-230-1030
Practice Address - Fax:810-230-1038
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6501000293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist