Blue Sky Physical Therapy

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

BLUE SKY PHYSICAL THERAPY

Practice address

21600 Harper Ave
St CLR Shores, MI 48080-2242

Phone

(678) 543-5635

NPI assigned

Jun 27, 2019

Organization subpart

No

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

Authorized official

Name

Wendell White

Title

Owner

Phone

(785) 435-6356

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1902467152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21600 HARPER AVE",
            "city": "ST CLR SHORES",
            "state": "MI",
            "postal_code": "480802242",
            "telephone_number": "678-543-5635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21600 HARPER AVE",
            "city": "ST CLR SHORES",
            "state": "MI",
            "postal_code": "480802242",
            "telephone_number": "678-543-5635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SKY PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-27",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-435-6356"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "OTHERURL",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21600 Harper Ave",
            "city": "St Clr Shores",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480802242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in St CLR Shores, MI
• Providers in St CLR Shores, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; 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.