Healthcare Provider Details

I. General information

NPI: 1164036778
Provider Name (Legal Business Name): LYNSEY RASCHKE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29822 S WIXOM RD
WIXOM MI
48393-3434
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-5826
  • Fax: 248-926-5830
Mailing address:
  • Phone: 248-926-5826
  • Fax: 248-926-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: