MEDICARE: MICHELE SYSKA MPT

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
1	225100000X	Physical Therapist	5501011286	MI

General Provider Information

NPI Number	:	1932524766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE SYSKA MPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-350-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	50174 SCHOENHERR RD STE 314
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48315-3136
Country	:	US
Telephone Number	:	586-884-5040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	09/22/2020

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