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General NPI Number Information
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NPI Number | 1356387450
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Entity Type | Individual
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Provider Name | TED ARTHUR LEZOTTE PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 09/18/2021
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Provider Practice Location Address
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Address Line | 5500 AUTO CLUB DR
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City | DEARBORN
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State | MI
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Zip | 48126-2779
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Country | US
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Telephone | 313-982-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 39809 MAZUCHET DR
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-1666
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Country | US
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Telephone | 734-347-4544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005446
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License Number State | MI
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