Healthcare Provider Details

I. General information

NPI: 1598255960
Provider Name (Legal Business Name): MATRX HEALTH & FITNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16145 LEONE DR
MACOMB MI
48042-4063
US

IV. Provider business mailing address

16145 LEONE DR
MACOMB MI
48042-4063
US

V. Phone/Fax

Practice location:
  • Phone: 586-232-3644
  • Fax: 248-579-0197
Mailing address:
  • Phone: 586-232-3644
  • Fax: 248-579-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number5501015621
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KRYSTINA NICOLE MILLER
Title or Position: CEO
Credential: PT, DPT, ATP
Phone: 586-232-3644