Provider Demographics
NPI:1104970342
Name:WUESTNICK, LORI K (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:WUESTNICK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15115 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9029
Mailing Address - Country:US
Mailing Address - Phone:810-750-1096
Mailing Address - Fax:810-750-1096
Practice Address - Street 1:3375 N LINDEN RD
Practice Address - Street 2:APT #151
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-5719
Practice Address - Country:US
Practice Address - Phone:810-230-1030
Practice Address - Fax:810-230-1038
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist