Gerald Lee Philo Jr., PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502000079 Issued in MI

Practice address

5500 Auto Club Dr Ste 150
Dearborn, MI 48126-2779

Phone

(313) 982-8266

Fax

(313) 982-8098

NPI assigned

Mar 17, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: gphilo3748@direct.hfhs.org

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1962087262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR STE 150",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-982-8266",
            "fax_number": "313-982-8098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR STE 150",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-982-8266",
            "fax_number": "313-982-8098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILO",
        "first_name": "GERALD",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502000079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gphilo3748@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "5500 Auto Club Dr Ste 150",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481262779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pharmcare Pharmacy Inc.
• Pharmcity LLC
• Rania Pharoan
• Jaclyn Mae Phillion, ACAGNP
• Taishawna Phillips
• Phoenix Mind Psychology PLLC
• Phylinx
• Physical Therapy Specialists of Dearborn LLC
• Physico PT, LLC
• Physio Care Rehab LLC

• Physical Therapy Assistant in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.

Verify at the official NPI Registry.