Basic Information
| Provider Information | |||||||||
| NPI: | 1588054605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IERVOLINO LEMERISE | ||||||||
| FirstName: | LUIZA | ||||||||
| MiddleName: | FERNANDES | ||||||||
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| Credential: | PT, DPT. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2826 DAVISON AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483262030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489096414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42804 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480381656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863232957 | ||||||||
| FaxNumber: | 5863230022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251N0400X | 5501017070 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No ID Information.