Healthcare Provider Details

I. General information

NPI: 1922172725
Provider Name (Legal Business Name): PATRICK ALDO DOLAN CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 BIDDLE ST
WYANDOTTE MI
48192-4668
US

IV. Provider business mailing address

1784 N TRENTON DR
TRENTON MI
48183-1865
US

V. Phone/Fax

Practice location:
  • Phone: 734-246-9007
  • Fax:
Mailing address:
  • Phone: 734-675-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: