Provider Demographics
NPI:1669894762
Name:PETZOLD, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:PETZOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HAMPTON CIR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4195
Mailing Address - Country:US
Mailing Address - Phone:248-289-1127
Mailing Address - Fax:248-289-1196
Practice Address - Street 1:130 HAMPTON CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4195
Practice Address - Country:US
Practice Address - Phone:248-289-1127
Practice Address - Fax:248-289-1196
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist