Michigan Tri-County Physical Therapy PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501009638 Issued in MI

Legal business name

MICHIGAN TRI-COUNTY PHYSICAL THERAPY PLLC

Practice address

28475 Van Dyke Ave
Warren, MI 48093-7132

Phone

(586) 806-4542

Fax

(586) 806-4546

NPI assigned

Dec 18, 2013

Last updated

Dec 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lolita M MaliskeyNPI 1548595598

Title

Physical Therapist

Phone

(586) 530-0904

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lolita Maria Maliskey

  • Physical Therapist
  • Southfield, MI
  • NPI 1548595598
  Medicare reassignment NPD Authorized official
• Maynard Buszek, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Southfield, MI
  • NPI 1003990037
  NPD (past)
• Annette G Desantis, MD

  • Physical Medicine & Rehabilitation Physician
  • Dearborn, MI
  • NPI 1730135492
  NPD (past)

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1083035067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28475 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937132",
            "telephone_number": "586-806-4542",
            "fax_number": "586-806-4546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28475 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937132",
            "telephone_number": "586-806-4542",
            "fax_number": "586-806-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN TRI-COUNTY PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-18",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "MALISKEY",
        "authorized_official_first_name": "LOLITA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "586-530-0904"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501009638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Warren, MI
• Providers in Warren, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.