Provider Demographics
NPI:1821763400
Name:GONDEK, CATHY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:GONDEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26485 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1330
Mailing Address - Country:US
Mailing Address - Phone:248-464-7086
Mailing Address - Fax:
Practice Address - Street 1:20270 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2000
Practice Address - Country:US
Practice Address - Phone:704-512-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist