Healthcare Provider Details

I. General information

NPI: 1962341800
Provider Name (Legal Business Name): WILDFLOWER PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E UNIVERSITY DR APT 402
ROCHESTER MI
48307-2157
US

IV. Provider business mailing address

507 E UNIVERSITY DR APT 402
ROCHESTER MI
48307-2157
US

V. Phone/Fax

Practice location:
  • Phone: 248-495-2688
  • Fax:
Mailing address:
  • Phone: 248-495-2688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY CVETKOVSKI
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 248-495-2688