Active NPI
Andrew Medalla, PT
- Physical Therapist
- Brownstown, MI
National Provider Identifier
1275737694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 31868 Tovenia Dr.
Brownstown, MI 48173-8756 - Phone
- (734) 236-4381
- NPI assigned
- Jun 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | Primary |
Addresses
Primary practice location
31868 Tovenia Dr.
Brownstown, MI 48173-8756
Mailing address
11650 Belleville Rd
Ste 102
Belleville, MI 48111-3382
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512518400000",
"number": "1275737694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11650 BELLEVILLE RD",
"address_2": "STE 102",
"city": "BELLEVILLE",
"state": "MI",
"postal_code": "481113382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31868 TOVENIA DR.",
"city": "BROWNSTOWN",
"state": "MI",
"postal_code": "481738756",
"telephone_number": "734-236-4381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDALLA",
"first_name": "ANDREW",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-06-11",
"last_updated": "2017-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brownstown, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.