Provider Demographics
NPI:1205264678
Name:ROSENZWEIG, MAGGIE (PT)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:ROSENZWEIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 W. ST. JOSEPH HWY
Mailing Address - Street 2:STE. 211
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917
Mailing Address - Country:US
Mailing Address - Phone:517-323-1124
Mailing Address - Fax:
Practice Address - Street 1:6105 W ST JOE HWY
Practice Address - Street 2:STE. 211
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4870
Practice Address - Country:US
Practice Address - Phone:517-323-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist