Phoenix Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PHOENIX PHYSICAL THERAPY INC

Practice address

45628 Van Dyke Ave
Utica, MI 48317-5366

Phone

(586) 726-4900

NPI assigned

May 8, 2019

Last updated

May 8, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eduardo Jacobs, RESIDENT AGENTNPI 1518517028

Title

Ceo

Phone

(586) 557-4441

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eduardo Jacobs

  • General Practice Physician
  • Sterling Heights, MI
  • NPI 1518517028
  NPD Authorized official

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1326603036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45628 VAN DYKE AVE",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483175366",
            "telephone_number": "586-726-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45628 VAN DYKE AVE",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483175366",
            "telephone_number": "586-726-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "EDUARDO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-557-4441",
        "authorized_official_credential": "RESIDENT AGENT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARA",
            "identifier": "802299670",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vamsi Krishna Panati, PT
• Tracy Ann Paraskevin, M.A., L.L.P.C., NCC
• Michael Shane Patterson, D.O.
• Stephen P Perry, MD
• Rachel Pfeifer, PTA
• Bernadine A. Pickett, M.A., L.P.C, NCC
• Rhyzianne Pimental
• Polanski Quinn and Associates PLLC
• Rebecca Polanski, MA, TLLP
• Jake Pradko, LPC

• Physical Therapy Clinic/Center in Utica, MI
• Providers in Utica, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.