Healthcare Provider Details

I. General information

NPI: 1508202151
Provider Name (Legal Business Name): THERA-PEDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
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: 586-566-0573
Mailing address:
  • Phone: 586-566-0326
  • Fax: 586-566-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE KELLEY
Title or Position: OWNER
Credential:
Phone: 586-212-3137