NPIMap

Organization Active NPI

Orthopedic Spine and Sports Therapy Inc

  • Physical Therapy Clinic/Center
  • Shelby Township, MI
National Provider Identifier
1154519064
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ORTHOPEDIC SPINE AND SPORTS THERAPY INC
Practice address
54945 Mound Rd
Shelby Township, MI 48316-6028
Phone
(586) 992-1500
Fax
(586) 992-8050
NPI assigned
Oct 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kathy Clark
Title
Credentialing
Phone
(586) 992-1500

Specialties & licenses 1

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

Addresses

Primary practice location

54945 Mound Rd
Shelby Township, MI 48316-6028

Mailing address

54945 Mound Rd
Shelby Township, MI 48316-6028
Phone (586) 992-1500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060404000482 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6901814888 Receives reassigned benefits from 4 practitioners
Practice locations: Shelby Township, MI

National Provider Directory

National Provider Directory

Locations

54945 Mound Rd
Shelby Township, MI 48316
Phone (586) 992-1500

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154519064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54945 MOUND RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483166028",
            "telephone_number": "586-992-1500",
            "fax_number": "586-992-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54945 MOUND RD",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483166028",
            "telephone_number": "586-992-1500",
            "fax_number": "586-992-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC SPINE AND SPORTS THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2022-07-21",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "586-992-1500"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.