Healthcare Provider Details

I. General information

NPI: 1740482553
Provider Name (Legal Business Name): MRS. BRIDGET LUCZYK FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 E JOLLY RD STE B
LANSING MI
48910-8552
US

IV. Provider business mailing address

3370 E JOLLY RD STE B
LANSING MI
48910-8552
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-5133
  • Fax:
Mailing address:
  • Phone: 517-272-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: