Healthcare Provider Details

I. General information

NPI: 1790012003
Provider Name (Legal Business Name): KATHLEEN ANN LEWANDOWSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43239 SCHOENHERR RD
STERLING HEIGHTS MI
48313-1957
US

IV. Provider business mailing address

2936 DAVISON AVE
AUBURN HILLS MI
48326-2040
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-2957
  • Fax: 586-323-0022
Mailing address:
  • Phone: 248-377-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: