Christa Milena Carlomusto, MPT
Individual provider Active NPI Physical Therapist · South Lyon, MI
NPI 1104941152 · NPPES record last updated Jan 15, 2021
Key facts
- NPI
- 1104941152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501016036 (MI)
- Practice address
- 25450 Villagewood CT
South Lyon, MI 48178-8041 - Phone
- (248) 308-0400
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
25450 Villagewood CT
South Lyon, MI 48178-8041
Phone (248) 308-0400
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130329000078 | MI | Practitioner - Physical Therapist in Private Practice | 8527161173 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2066 | NV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northville Physical Rehabilitation, P.C. | Physical Therapist | Past |
Accepting new patients |
| Jack D. Close and Associates | Physical Therapist | Past | Accepting new patients |
| Clark County Medical Group LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2066 | NV | |
| Physical Therapist | 225100000X | 5501016036 | MI | Yes |
Addresses
Primary practice location
25450 Villagewood CT
South Lyon, MI 48178-8041
Mailing address
25450 Villagewood CT
South Lyon, MI 48178-8041
Phone (248) 308-0400
Other practice location 1
3650 S Eastern Ave
100
Las Vegas, NV 89109-3379
Phone (702) 731-6873
Other providers in South Lyon, MI
- Tara Burley
- Buschs Inc
- Joshua Campbell
- Brian J Canadi
- Bryan Joseph Capen I
- Lauren Elizabeth Carney
- Jenna Marie Carter
- Jenna Cato
- Kadija Nazih Chamas
- Dave Chatel
All providers in South Lyon, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.