Active NPI
Nicholas Reder, DPT
- Physical Therapist
- Macomb, MI
National Provider Identifier
1063961407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501017781
- Practice address
- 48800 Romeo Plank Rd
Macomb, MI 48044 - Phone
- (586) 997-7100
- Fax
- (586) 997-7101
- NPI assigned
- Sep 27, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 5501017781 | MI | Primary |
Addresses
Primary practice location
48800 Romeo Plank Rd
Macomb, MI 48044
Mailing address
33900 Harper Ave Ste 104
Clinton TWP, MI 48035-4258
Phone (586) 350-2644
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 |
|---|---|---|---|
| 5501017781 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1063961407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33900 HARPER AVE STE 104",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480354258",
"telephone_number": "586-350-2644",
"fax_number": "586-541-3735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48800 ROMEO PLANK RD",
"city": "MACOMB",
"state": "MI",
"postal_code": "48044",
"telephone_number": "586-997-7100",
"fax_number": "586-997-7101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REDER",
"first_name": "NICHOLAS",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-27",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501017781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.