Active NPI
Stacy Dewald
- Physical Therapist
- Taylor, MI
National Provider Identifier
1669899076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501016697
- Practice address
- 21751 Ecorse Rd
Taylor, MI 48180-1846 - Phone
- (313) 359-8001
- Fax
- (313) 359-8002
- NPI assigned
- Mar 24, 2014
- Sex
- Female
- 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 | 5501016697 | MI | Primary |
Addresses
Primary practice location
21751 Ecorse Rd
Taylor, MI 48180-1846
Mailing address
33900 Harper Ave
Suite 104
Clinton Township, MI 48035
Phone (586) 416-9100
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436140800000",
"number": "1669899076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33900 HARPER AVE",
"address_2": "SUITE 104",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "48035",
"telephone_number": "586-416-9100",
"fax_number": "586-416-9103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21751 ECORSE RD",
"city": "TAYLOR",
"state": "MI",
"postal_code": "481801846",
"telephone_number": "313-359-8001",
"fax_number": "313-359-8002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWALD",
"first_name": "STACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-24",
"last_updated": "2015-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501016697",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.