Healthcare Provider Details

I. General information

NPI: 1679450043
Provider Name (Legal Business Name): SUZANNE CARDOSI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15500 19 MILE RD STE 330
CLINTON TWP MI
48038-6313
US

IV. Provider business mailing address

345 W FULLERTON PKWY APT 2107
CHICAGO IL
60614-2854
US

V. Phone/Fax

Practice location:
  • Phone: 586-412-0016
  • Fax: 586-412-0117
Mailing address:
  • Phone: 734-709-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: