NPIMap

Organization Active NPI

Private Health Physical Therapy & Wellness, PLC

  • Physical Therapist
  • Wixom, MI
National Provider Identifier
1316536113
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRIVATE HEALTH PHYSICAL THERAPY & WELLNESS, PLC
Practice address
28345 Beck Rd Ste 412
Wixom, MI 48393-4745
Phone
(248) 308-0400
NPI assigned
Jan 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Christa Milena Carlomusto, PT, MPT
Title
Founder/Owner
Phone
(248) 308-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

28345 Beck Rd Ste 412
Wixom, MI 48393-4745

Mailing address

25450 Villagewood CT
South Lyon, MI 48178-8041
Phone (248) 308-0400

Other practice location 1

25450 Villagewood Ct
South Lyon, MI 48178-8041
Phone (248) 308-0400

Other names 1

  • Private Health Physical therapy & Wellness Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210211002566 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2961817556 Practice locations: South Lyon, MI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1316536113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25450 VILLAGEWOOD CT",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481788041",
            "telephone_number": "248-308-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28345 BECK RD STE 412",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483934745",
            "telephone_number": "248-308-0400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25450 Villagewood Ct",
            "address_purpose": "LOCATION",
            "city": "South Lyon",
            "state": "MI",
            "postal_code": "481788041",
            "country_code": "US",
            "telephone_number": "248-308-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIVATE HEALTH PHYSICAL THERAPY & WELLNESS, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "CARLOMUSTO",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_middle_name": "MILENA",
        "authorized_official_title_or_position": "FOUNDER/OWNER",
        "authorized_official_telephone_number": "248-308-0400",
        "authorized_official_credential": "PT, MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Private Health Physical therapy & Wellness",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Private Health Physical therapy & Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wixom, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.