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NPI Code Detail

MEDICARE: PATRICIA VONDOLOSKI

MEDICARE: PATRICIA VONDOLOSKI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMI

General Provider Information

NPI Number : 1790128122
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA VONDOLOSKI
Provider Business Mailing Address
First Line : 50 N COLDWATER RD
Second Line : SUITE D
City : WEIDMAN
State : MI
Zip : 48893-8845
Country : US
Telephone Number : 989-546-7490
Fax Number : 989-546-7298
Provider Business Practice Location Address
First Line : 50 N COLDWATER RD
Second Line : SUITE D
City : WEIDMAN
State : MI
Zip : 48893-8845
Country : US
Telephone Number : 989-546-7490
Fax Number : 989-546-7298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2013
Last Update Date : 04/16/2013

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Directions to “ PATRICIA VONDOLOSKI ” Practice Location

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