Provider Demographics
NPI:1215057666
Name:CIESIELSKI, CAROL (PT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:CIESIELSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:CIESIELSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:816 CASTLEBAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2413
Mailing Address - Country:US
Mailing Address - Phone:248-375-2124
Mailing Address - Fax:
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 180
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-293-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010058222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic