Provider Demographics
NPI:1821875220
Name:FENWICK, AUDREY (DPT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:FENWICK
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 1:1800 W US HIGHWAY 223 STE 100
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8439
Mailing Address - Country:US
Mailing Address - Phone:517-263-3378
Mailing Address - Fax:517-263-4527
Practice Address - Street 1:3240 W CARLETON RD STE A
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-9458
Practice Address - Country:US
Practice Address - Phone:517-398-8039
Practice Address - Fax:517-212-8171
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist