Healthcare Provider Details

I. General information

NPI: 1144146945
Provider Name (Legal Business Name): CHARLES HISEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 VILLAGE PLACE BLVD
BRIGHTON MI
48116-2087
US

IV. Provider business mailing address

5988 TRAIL SIDE LN
HAMBURG TWP MI
48189-8163
US

V. Phone/Fax

Practice location:
  • Phone: 810-772-7600
  • Fax:
Mailing address:
  • Phone: 989-506-5649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019126
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: