NPIMap

Organization Active NPI

Foundation Manual Physical Therapy and Performance PLLC

  • Physical Therapy Clinic/Center
  • Royal Oak, MI
National Provider Identifier
1790453322
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FOUNDATION MANUAL PHYSICAL THERAPY AND PERFORMANCE PLLC
Practice address
120 Catalpa Dr
Royal Oak, MI 48067-1242
Phone
(586) 615-8585
NPI assigned
Aug 30, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Authorized official

Name
Mr. Douglas Edward Johnson, DPTNPI 1508905357
Title
Physical Therapist
Phone
(586) 615-8585

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

120 Catalpa Dr
Royal Oak, MI 48067-1242

Mailing address

1756 Huntington Blvd
Grosse Pointe Woods, MI 48236-1916
Phone (586) 615-8585

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL EMR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211101002108 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1153719729 Receives reassigned benefits from 6 practitioners
Practice locations: Clawson, MI

National Provider Directory

National Provider Directory
Tax ID family
Foundation Manual Physical Therapy and Performance2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

307 W 14 Mile Rd
Clawson, MI 48017
Phone (248) 929-9601

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1790453322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1756 HUNTINGTON BLVD",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361916",
            "telephone_number": "586-615-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CATALPA DR",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480671242",
            "telephone_number": "586-615-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATION MANUAL PHYSICAL THERAPY AND PERFORMANCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-30",
        "last_updated": "2021-08-30",
        "certification_date": "2021-04-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "586-615-8585",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "EMR",
            "affiliation": "N",
            "address_1": "120 Catalpa Dr",
            "city": "Royal Oak",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480671242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.