Individual provider Active NPI

Elizabath Shabu

  • Physical Therapist
  • Mount Clemens, MI
National Provider Identifier
1265239750
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501303866 Issued in MI
Practice address
243 Cass Ave Ste a
Mount Clemens, MI 48043-2124
Phone
(586) 783-7590
NPI assigned
Mar 3, 2025
Last updated
Mar 3, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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 5501303866 MI Primary

Addresses

Primary practice location

243 Cass Ave Ste a
Mount Clemens, MI 48043-2124

Mailing address

1773 Star Batt Dr
Rochester Hills, MI 48309-3708
Phone (248) 601-9207

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250331000699 MI Practitioner - Physical Therapist in Private Practice 2163945270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CKS of Mt Clemens LLCGroup PAC ID 0446321038, 17 clinicians

Practice addresses (Care Compare)

243 Cass Ave
Apt a
Mount Clemens, MI 48043-2124
Phone (586) 783-7590

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
CKS of Mt Clemens LLC Physical Therapist CurrentSince Mar 5, 2025 Accepting new patients

Locations

21550 Harrington St
Ste D
Clinton Twp, MI 48036
Phone (586) 783-7590

243 Cass Ave
Ste A
Mount Clemens, MI 48043
Phone (586) 783-7590

1773 Star Batt Dr
Rochester Hills, MI 48309
Phone (248) 650-4720

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1265239750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1773 STAR BATT DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483093708",
            "telephone_number": "248-601-9207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 CASS AVE STE A",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432124",
            "telephone_number": "586-783-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABU",
        "first_name": "ELIZABATH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501303866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.