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General NPI Number Information
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NPI Number | 1881996502
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Entity Type | Individual
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Provider Name | SUE MARIE MICHONSKI PT
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Gender | Female
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 10505 KINGSTON AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1159
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Country | US
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Telephone | 248-542-4359
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Fax |
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Provider Business Mailing Address
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Address Line | 10505 KINGSTON AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1159
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Country | US
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Telephone | 248-542-4359
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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 | 5501003641
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License Number State | MI
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