Active NPI
Krystal Matesic
- Physical Therapist
- Harper Woods, MI
National Provider Identifier
1255352571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501009514
- Practice address
- 19701 Vernier Rd
Harper Woods, MI 48225-1467 - Phone
- (313) 884-8920
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501009514 | MI | Primary |
Addresses
Primary practice location
19701 Vernier Rd
Harper Woods, MI 48225-1467
Mailing address
32224 Pierce St
Garden City, MI 48135-3238
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 650H230510 | Other | MI | BCBS |
| P00442694 | Other | MI | RAILROAD MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HC Rehab Solutions LLC | Physical Therapist | Past | Accepting new patients |
| In Home Rehab,LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Roseville, MI
- NPI 1942248422
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208908800000",
"number": "1255352571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32224 PIERCE ST",
"city": "GARDEN CITY",
"state": "MI",
"postal_code": "481353238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19701 VERNIER RD",
"city": "HARPER WOODS",
"state": "MI",
"postal_code": "482251467",
"telephone_number": "313-884-8920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATESIC",
"first_name": "KRYSTAL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2008-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501009514",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "650H230510",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PTAN",
"identifier": "P00442694",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harper Woods, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.