NPIMap

Organization Active NPI

Outlaw Physical Therapy, PLLC

  • Physical Therapy Clinic/Center
  • Niles, MI
National Provider Identifier
1316685092
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
OUTLAW PHYSICAL THERAPY, PLLC
Practice address
2882 Detroit Rd
Niles, MI 49120-9412
Phone
(574) 333-8775
NPI assigned
May 23, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Authorized official

Name
Derrick OutlawNPI 1396219663
Title
Physical Therapist
Phone
(574) 333-8775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2882 Detroit Rd
Niles, MI 49120-9412

Mailing address

2882 Detroit Rd
Niles, MI 49120-9412
Phone (574) 333-8775

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1316685092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2882 DETROIT RD",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491209412",
            "telephone_number": "574-333-8775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2882 DETROIT RD",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491209412",
            "telephone_number": "574-333-8775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTLAW PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "OUTLAW",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "574-333-8775"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.