=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245732833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA PISZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2018
-----------------------------------------------------
Last Update Date | 05/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16001 W 9 MILE RD
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48075-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-849-3465
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 JONES RD
-----------------------------------------------------
City | WATERFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48327-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-496-0045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 5502004469
-----------------------------------------------------
License Number State |
-----------------------------------------------------