Theresa Lynn Kissinger

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501009442 Issued in MI

Practice address

12150 30 Mile Rd
Washington Township, MI 48095-2035

Phone

(586) 336-2480

NPI assigned

Jul 13, 2018

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 6, 2021.

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1578049425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 WILCOX ST",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071448",
            "telephone_number": "248-709-9710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 30 MILE RD",
            "city": "WASHINGTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480952035",
            "telephone_number": "586-336-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSINGER",
        "first_name": "THERESA",
        "middle_name": "LYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-13",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501009442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tkissinger252301@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "12150 30 Mile Rd",
            "city": "Washington Township",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480952035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Flourish Therapeutic Services, PLLC
• Omar Francis, D.O
• David M Genoff, DPT
• Linda Lee Habrowski, PT
• Matthew James Jerore, DO
• Lifespan Therapy & Wellness, LLC
• Jennifer Marie Lucido, MA, LPC, NCC, CAADC
• Mary Therese Mattina
• Tulika Narain, M.D.
• Nebojsa Nikolovski

• All providers in Washington Township, MI
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.

Verify at the official NPI Registry.