Mirna Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

MIRNA PHYSICAL THERAPY LLC

Practice address

33449 Van Dyke Ave
Sterling HTS, MI 48312-5928

Phone

(248) 727-8997

NPI assigned

Jun 17, 2019

Last updated

Jun 17, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mirna Kakos

Title

Owner

Phone

(248) 727-8997

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1699335216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33449 VAN DYKE AVE",
            "city": "STERLING HTS",
            "state": "MI",
            "postal_code": "483125928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33449 VAN DYKE AVE",
            "city": "STERLING HTS",
            "state": "MI",
            "postal_code": "483125928",
            "telephone_number": "248-727-8997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRNA PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "KAKOS",
        "authorized_official_first_name": "MIRNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-727-8997"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "OTHERURL",
            "affiliation": "N",
            "endpointDescription": "OTHERURL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "33449 Van Dyke Ave",
            "city": "Sterling Hts",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483125928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Sterling HTS, MI
• Providers in Sterling HTS, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; 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.