| Doctor Name: | MR. STEPHEN JOSEPH DOMZALSKI |
| NPI Number: | 1760498828 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT, SCS, ATC, CSCS |
| License Number: | 5501010179 |
| Business Practice Address: | 5101 John C. Lodge 101 Matthaei Detroit, MI - 48202 |
| Business Phone Number: | 3135775833 |
| Business Fax Number: | 3135771012 |
| Mailing Address: | 5101 John C. Lodge, 101 Matthaei DETROIT |
| State: | MI |
| Postal Code: | 48202 |
| Phone Number: | 3135775833 |
| Fax Number: | 3135771012 |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 12/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501010179 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |