Great Lakes Physical Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501013760 Issued in MI

Legal business name

GREAT LAKES PHYSICAL THERAPY

Practice address

23300 Greenfield Rd
Suite 105
Oak Park, MI 48237-5237

Phone

(248) 968-4470

NPI assigned

Sep 3, 2009

Organization subpart

No

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

Authorized official

Name

Richi R Mittal, PT

Title

Physical Therapist

Phone

(248) 968-4470

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271116800000",
    "number": "1346473527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23300 GREENFIELD RD",
            "address_2": "SUITE 105",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482375237",
            "telephone_number": "248-968-4470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23300 GREENFIELD RD",
            "address_2": "SUITE 105",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482375237",
            "telephone_number": "248-968-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-03",
        "last_updated": "2010-04-13",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "RICHI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "248-968-4470",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501013760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Graceland Residential LLC
• Lyndon Caterra Graham
• Narie Graham, LPN
• Grateful Home Care Mi LLC
• Katherine Greager-Weingarten
• Greater Care Health Clinic
• Greater Heights Diagnostics, Inc.
• Greenfield and 9 Mile Medical Center PLLC
• Greenfield Labs LLC
• Greenfield Physical Therapy PLLC

• Physical Therapy Clinic/Center in Oak Park, MI
• Providers in Oak Park, 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 Apr 13, 2010; 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.