NPIMap

Organization Active NPI

Lifespan Therapy & Wellness, LLC

  • Physical Therapist
  • Washington Township, MI
National Provider Identifier
1669626289
Registry record updated Dec 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501010900 Issued in MI
Legal business name
LIFESPAN THERAPY & WELLNESS, LLC
Practice address
7457 Sawgress Dr
Washington Township, MI 48094
Phone
(248) 765-3153
NPI assigned
Nov 10, 2008
Last updated
Dec 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Katherine Mary Wybo, M.P.T.NPI 1316073893
Title
Co-Owner
Phone
(248) 765-3153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501010802 MI
Physical Therapist 225100000X 5501010889 MI
Physical Therapist 225100000X 5501010900 MI Primary

Addresses

Primary practice location

7457 Sawgress Dr
Washington Township, MI 48094

Mailing address

PO Box 567
Washington, MI 48094-0567
Phone (248) 765-3153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090114000555 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8527121714 Receives reassigned benefits from 1 practitioner
Practice locations: Farmington Hills, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230508800000",
    "number": "1669626289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 567",
            "city": "WASHINGTON",
            "state": "MI",
            "postal_code": "480940567",
            "telephone_number": "248-765-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7457 SAWGRESS DR",
            "city": "WASHINGTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48094",
            "telephone_number": "248-765-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN THERAPY & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-10",
        "last_updated": "2008-12-29",
        "status": "A",
        "authorized_official_last_name": "WYBO",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "248-765-3153",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010802",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010889",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501010900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.