Provider Demographics
NPI:1740552553
Name:MIKULEC, ALYSSA M (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:MIKULEC
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:1394 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1754
Practice Address - Country:US
Practice Address - Phone:248-218-5700
Practice Address - Fax:248-218-5703
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2019-07-16
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist