Provider Demographics
NPI:1194763631
Name:KONDRATEK, MELODIE DAWN (PT)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:DAWN
Last Name:KONDRATEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33481 W 14 MILE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1578
Mailing Address - Country:US
Mailing Address - Phone:248-661-6708
Mailing Address - Fax:248-661-8051
Practice Address - Street 1:33481 W 14 MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1578
Practice Address - Country:US
Practice Address - Phone:248-661-6708
Practice Address - Fax:248-661-8051
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist