Healthcare Provider Details

I. General information

NPI: 1649868886
Provider Name (Legal Business Name): MICHELLE WOJIE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52503 STAFFORD DR
MACOMB MI
48042-3816
US

IV. Provider business mailing address

52503 STAFFORD DR
MACOMB MI
48042-3816
US

V. Phone/Fax

Practice location:
  • Phone: 586-430-1333
  • Fax: 586-430-4691
Mailing address:
  • Phone: 586-430-1333
  • Fax: 586-430-4691

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: