Individual provider Active NPI

Wendy R Crusoe

  • Physical Therapist
  • Pontiac, MI
National Provider Identifier
1801049119
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501004738 Issued in MI
Practice address
900 Auburn Ave
Pontiac, MI 48342-3300
Phone
(248) 333-3335
Fax
(248) 333-7133
NPI assigned
Oct 30, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501004738 MI Primary

Addresses

Primary practice location

900 Auburn Ave
Pontiac, MI 48342-3300

Mailing address

900 Auburn Ave
Pontiac, MI 48342-3300
Phone (248) 333-3335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241011003373 MI Practitioner - Physical Therapist in Private Practice 9739611005 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Aug 5, 2024 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Aug 5, 2024 Accepting new patients

Locations

2885 10 Mile Rd NE
Rockford, MI 49341
Phone (616) 326-0010

46471 Hayes Rd
Shelby Township, MI 48315
Phone (586) 532-9559

7005 Pontiac Trl
West Bloomfield, MI 48323
Phone (248) 681-2476

101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436

Organizations & group practices 2

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": "1225324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225324800000",
    "number": "1801049119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 AUBURN AVE",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483423300",
            "telephone_number": "248-333-3335",
            "fax_number": "248-333-7133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 AUBURN AVE",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483423300",
            "telephone_number": "248-333-3335",
            "fax_number": "248-333-7133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUSOE",
        "first_name": "WENDY",
        "middle_name": "R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-30",
        "last_updated": "2008-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2008; 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.