Healthcare Provider Details

I. General information

NPI: 1063273837
Provider Name (Legal Business Name): MIKAELA POLLITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 E JOLLY RD STE C
LANSING MI
48910-5729
US

IV. Provider business mailing address

936 S CEDAR ST APT 1
MASON MI
48854-2052
US

V. Phone/Fax

Practice location:
  • Phone: 517-306-4919
  • Fax:
Mailing address:
  • Phone: 517-525-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502007945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: