Healthcare Provider Details

I. General information

NPI: 1700700812
Provider Name (Legal Business Name): ELISE RUDWINSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 JOHN R RD
TROY MI
48085-3625
US

IV. Provider business mailing address

141 HAMPTON CIR
ROCHESTER HILLS MI
48307-4103
US

V. Phone/Fax

Practice location:
  • Phone: 248-817-6788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: