Great Lakes Pain and Injury Center

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501013218 Issued in MI

Legal business name

GREAT LAKES PAIN AND INJURY CENTER

Practice address

15565 Northland Dr.
Suite 103 W
Southfield, MI 48075

Phone

(248) 809-2094

NPI assigned

Jan 13, 2017

Last updated

Jan 13, 2017By 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

Jaimon Jacob, PT

Title

Physical Therapist

Phone

(248) 809-2094

Specialties & licenses 1

Addresses

Locations

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.

• Jatinkumar Vaghasiya, PT

  • Physical Therapist
  • Southfield, MI
  • NPI 1538565973
  NPD (past)

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

{
    "created_epoch": "1484265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484265600000",
    "number": "1548706534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15565 NORTHLAND DR.",
            "address_2": "SUITE 103 W",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-809-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15565 NORTHLAND DR.",
            "address_2": "SUITE 103 W",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48075",
            "telephone_number": "248-809-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PAIN AND INJURY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-13",
        "last_updated": "2017-01-13",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JAIMON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "248-809-2094",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501013218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Clinical Care Services LLC
• Great Lakes Dialysis West LLC (Dialysis Care Center Great Lakes West)
• Great Lakes Foot & Ankle Institute PLLC
• Great Lakes Healthcare Services Inc
• Great Lakes Home Care Agency LLC
• Great Lakes Physicians of Southfield,PLLC
• Great Lakes Research Institute LLC
• Great Lakes Surgical Center Anesthesia, PLC
• Great Lakes Surgical Center LLC
• Great Lakes Surgical Center, LLC

• Physical Therapy Clinic/Center in Southfield, MI
• Providers in Southfield, 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 Jan 13, 2017; 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.