NPIMap

Organization Active NPI

Providence Physical Therapy

  • Physical Therapist
  • Southfield, MI
National Provider Identifier
1124416912
Registry record updated Dec 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
HR014291 Issued in MI
Legal business name
PROVIDENCE PHYSICAL THERAPY
Practice address
20180 W 12 Mile Rd
Suite 100
Southfield, MI 48076-5412
Phone
(248) 223-9230
NPI assigned
Dec 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2014

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

Authorized official

Name
Amena Saad
Title
Credentialer
Phone
(313) 655-4544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X HR014291 MI Primary

Addresses

Primary practice location

20180 W 12 Mile Rd
Suite 100
Southfield, MI 48076-5412

Mailing address

20180 W 12 Mile Rd
Suite 100
Southfield, MI 48076-5412

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1419984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419984000000",
    "number": "1124416912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20180 W 12 MILE RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20180 W 12 MILE RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480765412",
            "telephone_number": "248-223-9230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-31",
        "last_updated": "2014-12-31",
        "status": "A",
        "authorized_official_last_name": "SAAD",
        "authorized_official_first_name": "AMENA",
        "authorized_official_title_or_position": "CREDENTIALER",
        "authorized_official_telephone_number": "313-655-4544"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "HR014291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 31, 2014; 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.