Active NPI
Matthew Lee Opanasenko, DPT
- Physical Therapist
- Michigan Center, MI
National Provider Identifier
1558948596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501019224
- Practice address
- 4304 Page Ave
Michigan Center, MI 49254-1078 - Phone
- (517) 205-7586
- Fax
- (517) 205-0110
- NPI assigned
- Mar 25, 2021
- 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 Therapist | 225100000X | 5501019224 | MI | Primary |
Addresses
Primary practice location
4304 Page Ave
Michigan Center, MI 49254-1078
Mailing address
1608 4TH St
Jackson, MI 49203-4034
Phone (989) 413-2488
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mopanasenko619619@direct.hfhs.org |
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 |
|---|---|---|---|
| 5501019224 | MI | MD | Physical Therapist |
Interoperability endpoints
- mopanasenko619619@direct.hfhs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617753600000",
"number": "1558948596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1608 4TH ST",
"city": "JACKSON",
"state": "MI",
"postal_code": "492034034",
"telephone_number": "989-413-2488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4304 PAGE AVE",
"city": "MICHIGAN CENTER",
"state": "MI",
"postal_code": "492541078",
"telephone_number": "517-205-7586",
"fax_number": "517-205-0110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OPANASENKO",
"first_name": "MATTHEW",
"middle_name": "LEE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-25",
"last_updated": "2021-04-07",
"certification_date": "2021-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501019224",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mopanasenko619619@direct.hfhs.org",
"affiliation": "N",
"address_1": "4304 Page Ave",
"city": "Michigan Center",
"state": "MI",
"country_code": "US",
"postal_code": "492541078",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Michigan Center, MI
- Limitless Dental Care Center PLLC
- LTC Leonard LLC (LTC Welcome Michigan Center)
- LTC Leonard LLC (LTC Welcome Pharmacy Michigan Center)
- Hamead Moshrefi
- Erich Okonowski, MS
- John Gregory Palanci, D.D.S.
- Stacey Marie Payne, RN
- Melissa Lou Rappaport, MA, LLPC
- Mary Jo Ann Robb, LPN
- Craig Edward Ross, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.