NPIMap

Organization Active NPI

Great Lakes Physical Therapy and Rehabilitation LLC

  • Physical Therapy Clinic/Center
  • Warren, MI
National Provider Identifier
1124401625
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
E6533E Issued in MI
Legal business name
GREAT LAKES PHYSICAL THERAPY AND REHABILITATION LLC
Practice address
12434 E 12 Mile Rd Ste 101
Warren, MI 48093-3536
Phone
(586) 578-9121
Fax
(586) 578-9124
NPI assigned
Jul 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Mr. David James Stapels
Title
President
Phone
(586) 321-4563

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X E6533E MI Primary

Addresses

Primary practice location

12434 E 12 Mile Rd Ste 101
Warren, MI 48093-3536

Mailing address

12434 E 12 Mile Rd Ste 101
Warren, MI 48093-3536
Phone (586) 578-9121

Other identifiers 1

IdentifierTypeStateIssuer
12434OtherADDRESS

National Provider Directory

National Provider Directory

Locations

12434 E 12 Mile Rd
Ste 101
Warren, MI 48093
Phone (586) 578-9121

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1124401625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12434 E 12 MILE RD STE 101",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933536",
            "telephone_number": "586-578-9121",
            "fax_number": "586-578-9124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12434 E 12 MILE RD STE 101",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933536",
            "telephone_number": "586-578-9121",
            "fax_number": "586-578-9124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICAL THERAPY AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "STAPELS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-321-4563",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "E6533E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADDRESS",
            "identifier": "12434",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.