Jefforey McLanson, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502003670 Issued in MI

Practice address

5601 Hatchery Rd
Waterford, MI 48329-3451

Phone

(248) 674-5367

NPI assigned

Dec 17, 2014

Last updated

Dec 17, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1194123505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 BALD EAGLE LAKE RD",
            "city": "ORTONVILLE",
            "state": "MI",
            "postal_code": "484629038",
            "telephone_number": "248-431-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 HATCHERY RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293451",
            "telephone_number": "248-674-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLANSON",
        "first_name": "JEFFOREY",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502003670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Waterford, MI
• Providers in Waterford, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.