Individual provider Active NPI

Titus Mathew John

  • Physical Therapy Assistant
  • Troy, MI
National Provider Identifier
1306404652
Registry record updated Jun 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
5502005806 Issued in MI
Practice address
1959 Beech Lane Dr
Troy, MI 48083-1708
Phone
(248) 225-9742
NPI assigned
Jun 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 5502005806 MI Primary

Addresses

Primary practice location

1959 Beech Lane Dr
Troy, MI 48083-1708

Mailing address

1959 Beech Lane Dr
Troy, MI 48083-1708
Phone (248) 225-9742

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5502005806MIMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1559433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559433600000",
    "number": "1306404652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 BEECH LANE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831708",
            "telephone_number": "248-225-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 BEECH LANE DR",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831708",
            "telephone_number": "248-225-9742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHN",
        "first_name": "TITUS",
        "middle_name": "MATHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-02",
        "last_updated": "2019-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502005806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2019; 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.