Provider Demographics
NPI:1790738607
Name:PLUSZCZYK, EWA (PT)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:PLUSZCZYK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EWA
Other - Middle Name:
Other - Last Name:SWIDERSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7650 DIXIE HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2078
Mailing Address - Country:US
Mailing Address - Phone:248-620-9310
Mailing Address - Fax:248-922-5945
Practice Address - Street 1:1135 W UNIVERSITY DR STE 450
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-650-2400
Practice Address - Fax:248-650-4596
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F318300OtherMICHIGAN BCBS
MI1790738607Medicaid