Active NPI
Albert Waldus, P.T.
- Physical Therapist
- Dearborn, MI
National Provider Identifier
1063782720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501004265
- Practice address
- 635 N Elizabeth St
Dearborn, MI 48128-1704 - Phone
- (313) 330-3357
- Fax
- (313) 593-1939
- NPI assigned
- Jan 11, 2012
- Last updated
- Jan 11, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501004265 | MI | Primary |
Addresses
Primary practice location
635 N Elizabeth St
Dearborn, MI 48128-1704
Mailing address
635 N Elizabeth St
Dearborn, MI 48128-1704
Phone (313) 330-3357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501004265 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326240000000",
"number": "1063782720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "635 N ELIZABETH ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481281704",
"telephone_number": "313-330-3357",
"fax_number": "313-593-1939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "635 N ELIZABETH ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481281704",
"telephone_number": "313-330-3357",
"fax_number": "313-593-1939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDUS",
"first_name": "ALBERT",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-11",
"last_updated": "2012-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501004265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.