Michelle Zultak

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501017114 Issued in MI

Practice address

1250 E Michigan Ave
Grayling, MI 49738-7074

Phone

(989) 348-0314

Fax

(989) 348-0549

NPI assigned

Feb 23, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Michelle Cook Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northsport Physical Therapy & Rehabilitation P C

  • Physical Therapist
  • Gaylord, MI
  • NPI 1942387733
  NPD (past)

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1174915573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 E MICHIGAN AVE",
            "city": "GRAYLING",
            "state": "MI",
            "postal_code": "497387074",
            "telephone_number": "989-348-0314",
            "fax_number": "989-348-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E MICHIGAN AVE",
            "city": "GRAYLING",
            "state": "MI",
            "postal_code": "497387074",
            "telephone_number": "989-348-0314",
            "fax_number": "989-348-0549"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 E Houghton Ave",
            "address_purpose": "LOCATION",
            "city": "West Branch",
            "state": "MI",
            "postal_code": "486611127",
            "country_code": "US",
            "telephone_number": "989-343-3154 x3860",
            "fax_number": "989-343-3752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15520 19 MILE RD",
            "address_2": "STE 450",
            "address_purpose": "LOCATION",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480386332",
            "country_code": "US",
            "telephone_number": "586-416-2000",
            "fax_number": "586-416-2013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZULTAK",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-23",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501017114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "COOK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elaina Jolynn Suzzette Withers
• Woodland Home Care, LLC (Woodland Home Care)
• Laurie Woodruff, DC
• Jonathan Scott Wyllys, MA-LLPC
• Carrie A Zollner, PHARMD

• Physical Therapist in Grayling, MI
• Providers in Grayling, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; 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.