Active NPI
Legacy Healthcare Services Inc
- Physical Therapist
- Troy, MI
National Provider Identifier
1912505322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- LEGACY HEALTHCARE SERVICES INC
- Practice address
- 3400 Livernois Rd
Troy, MI 48083-5231 - Phone
- (248) 817-5666
- NPI assigned
- Oct 16, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. William Gill Wilson Jr.
- Title
- Cfo
- Phone
- (919) 424-5080
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
3400 Livernois Rd
Troy, MI 48083-5231
Mailing address
110 Horizon Dr Ste 310
Raleigh, NC 27615-4926
Phone (919) 424-5080
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602806400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1638489600000",
"number": "1912505322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 HORIZON DR STE 310",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276154926",
"telephone_number": "919-424-5080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 LIVERNOIS RD",
"city": "TROY",
"state": "MI",
"postal_code": "480835231",
"telephone_number": "248-817-5666"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LEGACY HEALTHCARE SERVICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2020-10-16",
"last_updated": "2021-12-03",
"certification_date": "2021-12-03",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "WILLIAM",
"authorized_official_middle_name": "GILL",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "919-424-5080",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.