NPIMap

Organization Active NPI

Professional PT and Rehab PC

  • Physical Therapist
  • Warren, MI
National Provider Identifier
1750597324
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501005394 Issued in MI
Legal business name
PROFESSIONAL PT AND REHAB PC
Practice address
31150 Hoover Rd
Ste C
Warren, MI 48093-7618
Phone
(586) 268-1929
Fax
(586) 268-1933
NPI assigned
May 14, 2007
Last updated
Sep 30, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
Smita Ahluwalia, RPTNPI 1679789283
Title
President
Phone
(248) 582-9907

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5501005394 MI Primary

Addresses

Primary practice location

31150 Hoover Rd
Ste C
Warren, MI 48093-7618

Mailing address

31150 Hoover Rd
Ste C
Warren, MI 48093-7618
Phone (586) 268-1929

Other identifiers 5

IdentifierTypeStateIssuer
104696147MedicaidMI
650F339030OtherMIBCBSM
125076OtherMIGREAT LAKES HEALTH PLAN
650019090OtherMIRAILROAD MEDICARE
P106004OtherMIBLUECARE NETWORK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1750597324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31150 HOOVER RD",
            "address_2": "STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937618",
            "telephone_number": "586-268-1929",
            "fax_number": "586-268-1933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31150 HOOVER RD",
            "address_2": "STE C",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480937618",
            "telephone_number": "586-268-1929",
            "fax_number": "586-268-1933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PT AND REHAB PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "AHLUWALIA",
        "authorized_official_first_name": "SMITA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-582-9907",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104696147",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "650F339030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "125076",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650019090",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE NETWORK",
            "identifier": "P106004",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.