Individual provider Active NPI

Ann L Berry, AT, PTA, ATC

  • Physical Therapy Assistant
  • Canton, MI
National Provider Identifier
1770575532
Registry record updated Sep 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
5502004056 Issued in MI
Practice address
45610 Cherry Hill Rd
Canton, MI 48187-5072
Phone
(734) 981-1500
Fax
(734) 981-1515
NPI assigned
Aug 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 5502004056 MI Primary
Athletic Trainer 2255A2300X 2601000001 MI

Addresses

Primary practice location

45610 Cherry Hill Rd
Canton, MI 48187-5072

Mailing address

45610 Cherry Hill Rd
Canton, MI 48187-5072
Phone (734) 981-1500

Other identifiers 2

IdentifierTypeStateIssuer
5502004056OtherMIPTA LICENSE
2601000001OtherMISTATE 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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5502004056MIMDPhysical Therapy Assistant
2601000001MIMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-Rehab, Inc. CurrentSince Nov 5, 2023 Accepting new patients

Locations

45610 Cherry Hill Rd
Canton, MI 48187
Phone (734) 981-1500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379980800000",
    "number": "1770575532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45610 CHERRY HILL RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875072",
            "telephone_number": "734-981-1500",
            "fax_number": "734-981-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45610 CHERRY HILL RD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481875072",
            "telephone_number": "734-981-1500",
            "fax_number": "734-981-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "ANN",
        "middle_name": "L",
        "credential": "AT, PTA, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2013-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502004056",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE",
            "identifier": "5502004056",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2601000001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2013; 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.