Healthcare Provider Details

I. General information

NPI: 1821209917
Provider Name (Legal Business Name): CANDIE MARIE DJURASAJ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15979 HALL RD. SUITE 150
MACOMB MI
48044
US

IV. Provider business mailing address

26644 GROVELAND ST
ROSEVILLE MI
48066-3368
US

V. Phone/Fax

Practice location:
  • Phone: 586-416-8430
  • Fax: 586-416-8440
Mailing address:
  • Phone: 586-675-6546
  • 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: