Active NPI
Jason Donald Kroulik, DPT
- Physical Therapist
- Dearborn, MI
National Provider Identifier
1801095146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501013385
- Practice address
- 23852 Michigan Ave
Dearborn, MI 48124-1829 - Phone
- (313) 565-4222
- Fax
- (313) 565-8703
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501013385 | MI | Primary |
Addresses
Primary practice location
23852 Michigan Ave
Dearborn, MI 48124-1829
Mailing address
33200 W 14 Mile Rd
West Bloomfield, MI 48322-3563
Phone (248) 538-7607
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501013385 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323216000000",
"number": "1801095146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33200 W 14 MILE RD",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223563",
"telephone_number": "248-538-7607",
"fax_number": "248-538-7623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23852 MICHIGAN AVE",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241829",
"telephone_number": "313-565-4222",
"fax_number": "313-565-8703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROULIK",
"first_name": "JASON",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2011-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501013385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.