Provider Demographics
NPI:1952377244
Name:PERUSKI, ELIZABETH ANN (DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PERUSKI
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2740
Mailing Address - Country:US
Mailing Address - Phone:248-236-0035
Mailing Address - Fax:248-236-0035
Practice Address - Street 1:53 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6433
Practice Address - Country:US
Practice Address - Phone:248-236-0035
Practice Address - Fax:248-236-0125
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012728208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F33354OtherBCBS
MI0F33354OtherBCBS