NPIMap

Organization Active NPI

Spine and Aquatic Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Livonia, MI
National Provider Identifier
1346947116
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SPINE AND AQUATIC PHYSICAL THERAPY LLC
Practice address
15240 Merriman Rd
Livonia, MI 48154-3570
Phone
(734) 513-7755
NPI assigned
Feb 13, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Sanjay Thakral, DPTNPI 1811055502
Title
Owner
Phone
(734) 513-7755

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

15240 Merriman Rd
Livonia, MI 48154-3570

Mailing address

PO Box 703207
Plymouth, MI 48170-0994

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230822000574 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3577925627 Receives reassigned benefits from 5 practitioners
Practice locations: Livonia, MI

National Provider Directory

National Provider Directory

Locations

15240 Merriman Rd
Livonia, MI 48154
Phone (734) 513-7755

Practitioners & affiliated clinicians

Practitioners 9

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": "1676246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1346947116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 703207",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481700994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15240 MERRIMAN RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481543570",
            "telephone_number": "734-513-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND AQUATIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-13",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "THAKRAL",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-513-7755",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.