Healthcare Provider Details

I. General information

NPI: 1376044941
Provider Name (Legal Business Name): EDWARD SEZNIAK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 COOLIDGE HWY
ROYAL OAK MI
48073-1026
US

IV. Provider business mailing address

2087 WARRINGTON RD
ROCHESTER HILLS MI
48307-3773
US

V. Phone/Fax

Practice location:
  • Phone: 248-655-5700
  • Fax: 248-655-5701
Mailing address:
  • Phone: 248-867-9286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001782
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: