Active NPI
Ryan James Angelosanto, PTA
- Physical Therapy Assistant
- Novi, MI
National Provider Identifier
1538817309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502005470
- Practice address
- 43443 Grand River Ave Ste 200
Novi, MI 48375-1106 - Phone
- (248) 305-9200
- Fax
- (248) 305-9330
- NPI assigned
- Mar 11, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502005470 | MI | Primary |
Addresses
Primary practice location
43443 Grand River Ave Ste 200
Novi, MI 48375-1106
Mailing address
43443 Grand River Ave Ste 200
Novi, MI 48375-1106
Phone (248) 305-9200
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 |
|---|---|---|---|
| 5502005470 | MI | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spine and Extremity Institute of South Lyon, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- South Lyon, MI
- NPI 1811209968
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646956800000",
"number": "1538817309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43443 GRAND RIVER AVE STE 200",
"city": "NOVI",
"state": "MI",
"postal_code": "483751106",
"telephone_number": "248-305-9200",
"fax_number": "248-305-9330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43443 GRAND RIVER AVE STE 200",
"city": "NOVI",
"state": "MI",
"postal_code": "483751106",
"telephone_number": "248-305-9200",
"fax_number": "248-305-9330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANGELOSANTO",
"first_name": "RYAN",
"middle_name": "JAMES",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-11",
"last_updated": "2022-03-11",
"certification_date": "2022-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502005470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.