Healthcare Provider Details

I. General information

NPI: 1558835124
Provider Name (Legal Business Name): ALEXANDER PIETERS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48800 ROMEO PLANK RD
MACOMB MI
48044-2159
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-7100
  • Fax: 586-434-3720
Mailing address:
  • Phone: 586-350-2644
  • Fax: 586-541-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019043
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: