Active NPI
Mary Roberts, PT
- Physical Therapist
- Southfield, MI
National Provider Identifier
1124359153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501013665
- Practice address
- 23800 W 10 Mile Rd
Suite 193
Southfield, MI 48033-3176 - Phone
- (248) 827-1100
- NPI assigned
- Jan 14, 2010
- Sex
- Female
- 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 | 5501013665 | MI | Primary |
Addresses
Primary practice location
23800 W 10 Mile Rd
Suite 193
Southfield, MI 48033-3176
Mailing address
23800 W 10 Mile Rd
Suite 193
Southfield, MI 48033-3176
Phone (248) 827-1100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5501013665 | Other | MI | LICENSE |
Other names 1
- Mary Pietsch
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 |
|---|---|---|---|
| 5501013665 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263427200000",
"number": "1124359153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23800 W 10 MILE RD",
"address_2": "SUITE 193",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333176",
"telephone_number": "248-827-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23800 W 10 MILE RD",
"address_2": "SUITE 193",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480333176",
"telephone_number": "248-827-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "MARY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-14",
"last_updated": "2010-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501013665",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "5501013665",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "PIETSCH",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.