Provider Demographics
NPI:1790128122
Name:VONDOLOSKI, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:VONDOLOSKI
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 1:50 N COLDWATER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893-8845
Mailing Address - Country:US
Mailing Address - Phone:989-546-7490
Mailing Address - Fax:989-546-7298
Practice Address - Street 1:50 N COLDWATER RD
Practice Address - Street 2:SUITE D
Practice Address - City:WEIDMAN
Practice Address - State:MI
Practice Address - Zip Code:48893-8845
Practice Address - Country:US
Practice Address - Phone:989-546-7490
Practice Address - Fax:989-546-7298
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist