Provider Demographics
NPI:1205895356
Name:RADLOWSKI, MELISSA SUSAN (DPT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUSAN
Last Name:RADLOWSKI
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 1:6438 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:810-220-5805
Practice Address - Street 1:5757 WHITMORE LAKE RD
Practice Address - Street 2:STE 900
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-220-5793
Practice Address - Fax:810-220-5805
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRT470004OtherMCARE
MI30644OtherBCBS
MI236683Medicare ID - Type Unspecified