Active NPI
Theodore James St. John, DPT
- Physical Therapist
- Freeland, MI
National Provider Identifier
1679219638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501301844
- Practice address
- 5866 Midland Rd
Freeland, MI 48623-8707 - Phone
- (989) 573-8588
- Fax
- (989) 573-8589
- NPI assigned
- May 11, 2022
- 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 | 5501301844 | MI | Primary |
Addresses
Primary practice location
5866 Midland Rd
Freeland, MI 48623-8707
Mailing address
5866 Midland Rd
Freeland, MI 48623-8707
Phone (989) 573-8588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| S325792367996 | Other | MI | DRIVERS LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501301844 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654732800000",
"number": "1679219638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5866 MIDLAND RD",
"city": "FREELAND",
"state": "MI",
"postal_code": "486238707",
"telephone_number": "989-573-8588",
"fax_number": "989-573-8589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5866 MIDLAND RD",
"city": "FREELAND",
"state": "MI",
"postal_code": "486238707",
"telephone_number": "989-573-8588",
"fax_number": "989-573-8589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ST. JOHN",
"first_name": "THEODORE",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-11",
"last_updated": "2022-06-09",
"certification_date": "2022-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501301844",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "S325792367996",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Freeland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.