Active NPI
Jeji Kurian Mathew
- Physical Therapist
- Detroit, MI
National Provider Identifier
1629579370
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501009700
- Practice address
- 22811 W 7 Mile Rd
Detroit, MI 48219-1739 - Phone
- (313) 534-1440
- NPI assigned
- Feb 27, 2018
- 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 | 5501009700 | MI | Primary |
Addresses
Primary practice location
22811 W 7 Mile Rd
Detroit, MI 48219-1739
Mailing address
4038 Hanover Dr
Troy, MI 48085-4700
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 |
|---|---|---|---|
| 5501009700 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519689600000",
"number": "1629579370",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4038 HANOVER DR",
"city": "TROY",
"state": "MI",
"postal_code": "480854700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22811 W 7 MILE RD",
"city": "DETROIT",
"state": "MI",
"postal_code": "482191739",
"telephone_number": "313-534-1440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "JEJI",
"middle_name": "KURIAN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-27",
"last_updated": "2018-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501009700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.