NPIMap

Organization Active NPI

MMG 1PC

Doing business as Millenniun Physical Therapy Center

  • Physical Therapist
  • Southfield, MI
National Provider Identifier
1972700607
Registry record updated Sep 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MMG 1PC
Doing business as
Millenniun Physical Therapy Center
Practice address
26400 W 12 Mile Rd
Suite 25
Southfield, MI 48034-1700
Phone
(248) 864-4444
Fax
(248) 864-4445
NPI assigned
Jun 27, 2007
Last updated
Sep 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2018

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

Authorized official

Name
Dr. Geoffrey A. Trivax, M.D.NPI 1164407730
Title
President
Phone
(248) 354-9666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

26400 W 12 Mile Rd
Suite 25
Southfield, MI 48034-1700

Mailing address

29992 Northwestern Hwy Ste C
Farmington Hills, MI 48334-3292
Phone (248) 851-1430

Other identifiers 1

IdentifierTypeStateIssuer
30044OtherMIBLUE SHIELD

Other names 1

  • MILLENNIUN PHYSICAL THERAPY CENTER Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537401600000",
    "number": "1972700607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29992 NORTHWESTERN HWY STE C",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343292",
            "telephone_number": "248-851-1430",
            "fax_number": "248-851-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26400 W 12 MILE RD",
            "address_2": "SUITE 25",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341700",
            "telephone_number": "248-864-4444",
            "fax_number": "248-864-4445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG 1PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2018-09-20",
        "status": "A",
        "authorized_official_last_name": "TRIVAX",
        "authorized_official_first_name": "GEOFFREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-354-9666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "30044",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MILLENNIUN PHYSICAL THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MILLENNIUN PHYSICAL THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.