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NPI Code Detail

MEDICARE: MRS. DEANNA RENEE WIRICK MPT

MEDICARE: MRS. DEANNA RENEE WIRICK 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
12251X0800XOrthopedic Physical Therapist5501010198MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F228781OTHERMIBCBSM

General Provider Information

NPI Number : 1942701735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEANNA RENEE WIRICK MPT
Provider Business Mailing Address
First Line : 22019 NORMANDY AVE
Second Line :
City : EASTPOINTE
State : MI
Zip : 48021-2511
Country : US
Telephone Number : 586-776-3728
Fax Number :
Provider Business Practice Location Address
First Line : 20952 E 12 MILE RD STE 110
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48081-3202
Country : US
Telephone Number : 586-498-3500
Fax Number : 586-498-3510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2018
Last Update Date : 02/27/2018

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