MEDICARE: PIETRUCK THERAPY SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1932634219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIETRUCK THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	220 COLLINGWOOD ST STE 130
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3842
Country	:	US
Telephone Number	:	734-786-2626
Fax Number	:	734-997-5015

Provider Business Practice Location Address
First Line	:	220 COLLINGWOOD ST STE 130
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-3842
Country	:	US
Telephone Number	:	734-786-2626
Fax Number	:	734-997-5015

Authorized Official
Title or Position	:	OWNER
Name	:	LINDSAY PIETRUCK BAILEY
Credential	:
Telephone Number	:	734-786-2626

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	04/13/2024

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