Healthcare Provider Details

I. General information

NPI: 1528764578
Provider Name (Legal Business Name): CARLY CHRISTY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16137 LEONE DR
MACOMB MI
48042-4063
US

IV. Provider business mailing address

16137 LEONE DR
MACOMB MI
48042-4063
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-0326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: