Michael Thomas Prudhomme, D.P.T.
Individual provider Active NPI Orthopedic Physical Therapist · Riverview, MI
NPI 1548564255 · NPPES record last updated Aug 28, 2014
Key facts
- NPI
- 1548564255
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 5501010391 (MI)
- Practice address
- 13638 Sibley Rd
Riverview, MI 48193-7406 - Phone
- (734) 288-3739
- Fax
- (734) 288-3745
- NPI assigned
- Jan 10, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rehab Connection Inc
Practice addresses (Care Compare)
19725 Allen Rd
Suite B
Brownstown TWP, MI 48183-1090
Phone (734) 250-8358
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140808001609 | MI | Practitioner - Physical Therapist in Private Practice | 6406073857 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501010391 | MI | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehab Connection Inc | Orthopedic | Current |
Accepting new patients |
| Michigan Rehabilitation Specialists of Fowlerville, LLC | Current |
Accepting new patients | |
| Michigan Rehabilitation Specialists of Fowlerville LLC | Orthopedic | Current |
Accepting new patients |
Locations
4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001
5700 Jackson Rd
Ann Arbor, MI 48103
Phone (734) 926-4710
19725 Allen Rd
Ste B
Brownstown Twp, MI 48183
Phone (734) 250-8358
10078 Lapeer Rd
Ste B
Davison, MI 48423
Phone (810) 653-6200
10860 Highland Rd
Hartland, MI 48353
Phone (810) 632-1000
13638 Sibley Rd
Riverview, MI 48193
Phone (734) 288-3739
5210 Highland Rd
Ste 100
Waterford, MI 48327
Phone (248) 674-9560
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 5501010391 | MI | Yes |
Addresses
Primary practice location
13638 Sibley Rd
Riverview, MI 48193-7406
Mailing address
13638 Sibley Rd
Riverview, MI 48193-7406
Phone (734) 288-3739
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OH28738 | Other | MI | BCBSM PIN |
Other providers in Riverview, MI
- Marcella Pertee
- Frances Conswayla Phillips
- Rodney H Poling
- Howard Paul Potocsky
- Premier Urology PLLC
- Pulmonary and Sleep Medicine PC
- Pulmonary Critical Care & Sleep Medicine PC
- Pulmonary Critical Care and Sleep Medicine
- Quarry Physicians, P.C.
- Ann Marie Quick
All providers in Riverview, MI · Orthopedic Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.