Individual provider Active NPI

Michael Jordan Peres, DPT, PT

  • Physical Therapist
  • Waterford, MI
National Provider Identifier
1023809902
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501303996 Issued in MI
Practice address
1187 W Huron St
Waterford, MI 48328-3736
Phone
(248) 977-4594
Fax
(248) 977-4597
NPI assigned
May 13, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501303996 MI Primary

Addresses

Primary practice location

1187 W Huron St
Waterford, MI 48328-3736

Mailing address

1187 W Huron St
Waterford, MI 48328-3736
Phone (248) 977-4594

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250616000706 MI Practitioner - Physical Therapist in Private Practice 9830600014 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michigan Fyzpt-II FyzicalGroup PAC ID 0143767228, 3 clinicians
Novi DPT LLCGroup PAC ID 7517059132, 6 clinicians
Michigan Fyzpt-I LLCGroup PAC ID 0941646954, 5 clinicians

Practice addresses (Care Compare)

16925 Haggerty Rd
Northville, MI 48168-3955
Phone (248) 826-5600

21600 Novi Rd
400 Novi Doctors of PT
Novi, MI 48375-5605
Phone (248) 679-5396

41430 Grand River Ave
Suite B
Novi, MI 48375-1876
Phone (248) 826-5600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Novi DPT LLC Physical Therapist CurrentSince Sep 2, 2025 Accepting new patients
Dearborn Physical Therapy LTD. Physical Therapist CurrentSince Jun 4, 2025 Accepting new patients
Dearborn Physical Therapy LTD. Physical Therapist Current Accepting new patients

Locations

23852 Michigan Ave
Dearborn, MI 48124
Phone (313) 565-4222

18899 W 12 Mile Rd
Lathrup Village, MI 48076
Phone (248) 219-4772

21600 Novi Rd
Ste 400
Novi, MI 48375
Phone (248) 679-5396

1187 W Huron St
Waterford, MI 48328
Phone (248) 618-3050

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1023809902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1187 W HURON ST",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283736",
            "telephone_number": "248-977-4594",
            "fax_number": "248-977-4597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1187 W HURON ST",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483283736",
            "telephone_number": "248-977-4594",
            "fax_number": "248-977-4597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERES",
        "first_name": "MICHAEL",
        "middle_name": "JORDAN",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-13",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.