Active NPI
John Penley, AT
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- White Lake, MI
National Provider Identifier
1326583170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2601001645
- Practice address
- 1630 Bogie Lake Rd
White Lake, MI 48383 - Phone
- (734) 474-0783
- NPI assigned
- Jan 4, 2017
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2601001645 | MI | Primary |
Addresses
Primary practice location
1630 Bogie Lake Rd
White Lake, MI 48383
Mailing address
PO Box 1356
Brighton, MI 48116
Phone (734) 474-0783
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2601001645 | MI | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1326583170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1356",
"city": "BRIGHTON",
"state": "MI",
"postal_code": "48116",
"telephone_number": "734-474-0783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 BOGIE LAKE RD",
"city": "WHITE LAKE",
"state": "MI",
"postal_code": "48383",
"telephone_number": "734-474-0783"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENLEY",
"first_name": "JOHN",
"credential": "AT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-04",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "MI",
"license": "2601001645",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.