Individual provider Active NPI

Cullen Lane, DPT

  • Physical Therapist
  • Livonia, MI
National Provider Identifier
1255093712
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501020201 Issued in MI
Practice address
36622 Five Mile Rd Ste 102
Livonia, MI 48154-1900
Phone
(734) 542-0200
NPI assigned
Oct 12, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501020201 MI Primary

Addresses

Primary practice location

36622 Five Mile Rd Ste 102
Livonia, MI 48154-1900

Mailing address

542 Snyder Rd
Highland, MI 48357-2859
Phone (231) 570-0142

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211028001655 MI Practitioner - Physical Therapist in Private Practice 4486042116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mendelson Orthopedics PCGroup PAC ID 8426008368, 69 clinicians

Practice addresses (Care Compare)

13488 E 11 Mile Rd
Mendelson Kornblum Physical Therapy
Warren, MI 48089-1366
Phone (586) 439-6243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501020201MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mendelson Orthopedics PC Current Accepting new patients
Mendelson Orthopedics PC CurrentSince Oct 25, 2021 Accepting new patients
Mendelson Orthopedics PC CurrentSince Oct 25, 2021 Accepting new patients

Locations

7684 Solutions Ctr
#777684
Chicago, IL 60677

36622 5 Mile Rd
Ste 102
Livonia, MI 48154
Phone (734) 542-9770

14555 Levan Rd
Ste 215
Livonia, MI 48154
Phone (734) 542-0200

36622 5 Mile Rd
Livonia, MI 48154
Phone (734) 542-0200

5107 Rochester Rd
Troy, MI 48085
Phone (248) 723-2477

500 Stephenson Hwy
#300
Troy, MI 48083
Phone (586) 439-6258

13488 E 11 Mile Rd
Warren, MI 48089
Phone (586) 439-6243

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633996800000",
    "number": "1255093712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "542 SNYDER RD",
            "city": "HIGHLAND",
            "state": "MI",
            "postal_code": "483572859",
            "telephone_number": "231-570-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36622 FIVE MILE RD STE 102",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541900",
            "telephone_number": "734-542-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "CULLEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501020201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.