Provider Demographics
NPI:1023510062
Name:DUDEK, DORENE (PT)
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:
Last Name:DUDEK
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 1:40000 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2134
Mailing Address - Country:US
Mailing Address - Phone:248-380-6222
Mailing Address - Fax:248-380-6224
Practice Address - Street 1:14300 N BECK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3377
Practice Address - Country:US
Practice Address - Phone:248-380-6222
Practice Address - Fax:248-380-6224
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist