Provider Demographics
NPI:1740512839
Name:HETHERWICK, ELIZABETH A (PT, DPT, ATP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:HETHERWICK
Suffix:
Gender:F
Credentials:PT, DPT, ATP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:KRYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, ATP
Mailing Address - Street 1:8250 LOCKERBIE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MI
Mailing Address - Zip Code:49269-9335
Mailing Address - Country:US
Mailing Address - Phone:517-740-8875
Mailing Address - Fax:
Practice Address - Street 1:8250 LOCKERBIE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:MI
Practice Address - Zip Code:49269-9335
Practice Address - Country:US
Practice Address - Phone:517-740-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1379518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist