Provider Demographics
NPI:1952866865
Name:GLUCHOWSKI, DARIUSZ (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:DARIUSZ
Middle Name:
Last Name:GLUCHOWSKI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19337 SKYLINE ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4531
Mailing Address - Country:US
Mailing Address - Phone:586-495-9331
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2200
Practice Address - Country:US
Practice Address - Phone:248-358-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist