Provider Demographics
NPI:1770118408
Name:PRZYBYLOWICZ, MARINA (PT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PRZYBYLOWICZ
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 1:9368 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4610
Mailing Address - Country:US
Mailing Address - Phone:248-573-7940
Mailing Address - Fax:248-573-7941
Practice Address - Street 1:582 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2000
Practice Address - Country:US
Practice Address - Phone:248-573-7940
Practice Address - Fax:248-573-7941
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298148225100000X
MI5501019622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist