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General NPI Number Information
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NPI Number | 1730416470
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Entity Type | Individual
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Provider Name | LORA CATHERINE FEDESON P.T., C.M.T.
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Gender | Female
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 1100 CORPORATE OFFICE DR SUITE 100
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City | MILFORD
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State | MI
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Zip | 48381-5001
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Country | US
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Telephone | 248-684-1107
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Fax | 248-684-1681
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Provider Business Mailing Address
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Address Line | 30345 WICKLOW RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-4769
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Country | US
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Telephone | 248-471-4586
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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 | 5501004510
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License Number State | MI
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