Sharaun Whitaker – Physical Therapy Clinic/Center

Key facts

NPI: 1912583246
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapy Clinic/Center 261QP2000X
License: 5501019267 (MI)
Practice address: 6525 2ND Ave
Detroit, MI 48202-3006
Phone: (313) 972-4140
NPI assigned: Mar 18, 2021
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
5501019267	MI	MD	Physical Therapy Clinic/Center

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapy Clinic/Center	261QP2000X	5501019267	MI	Yes

Addresses

Primary practice location

6525 2ND Ave
Detroit, MI 48202-3006

Mailing address

6525 2ND Ave
Detroit, MI 48202-3006
Phone (313) 972-4140

Electronic endpoints

Type	Endpoint	Use	Affiliation
Direct Messaging Address	swhitaker620148@direct.hfhs.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 23, 2021.

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1912583246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006",
            "telephone_number": "313-972-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 2ND AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023006",
            "telephone_number": "313-972-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "SHARAUN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-18",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501019267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swhitaker620148@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "6525 2nd Ave",
            "city": "Detroit",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482023006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Detroit, MI

All providers in Detroit, MI · Physical Therapy Clinic/Center in Michigan

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.