Provider Demographics
NPI:1851543953
Name:HOUSKA, MARCIE M (DPT)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:M
Last Name:HOUSKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:M
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:555 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1925
Mailing Address - Country:US
Mailing Address - Phone:989-666-4331
Mailing Address - Fax:
Practice Address - Street 1:3315 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4600
Practice Address - Country:US
Practice Address - Phone:517-364-8600
Practice Address - Fax:517-364-8625
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist