Healthcare Provider Details

I. General information

NPI: 1053904912
Provider Name (Legal Business Name): AMY VITALE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY BLICHARSKI DPT

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 KERCHEVAL AVE
GROSSE POINTE FARMS MI
48236-3610
US

IV. Provider business mailing address

22809 FRANCIS ST
SAINT CLAIR SHORES MI
48082-1795
US

V. Phone/Fax

Practice location:
  • Phone: 313-640-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: