Provider Demographics
NPI:1487297750
Name:RIED, DWENDE
Entity type:Individual
Prefix:
First Name:DWENDE
Middle Name:
Last Name:RIED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17515 W 9 MILE RD STE 740
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4413
Mailing Address - Country:US
Mailing Address - Phone:313-587-9938
Mailing Address - Fax:248-796-9985
Practice Address - Street 1:17515 W 9 MILE RD STE 740
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4413
Practice Address - Country:US
Practice Address - Phone:313-587-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist