Healthcare Provider Details

I. General information

NPI: 1669381521
Provider Name (Legal Business Name): MERTZ SPORTS PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46500 DESOTO CT
NOVI MI
48377-1731
US

IV. Provider business mailing address

46500 DESOTO CT
NOVI MI
48377-1731
US

V. Phone/Fax

Practice location:
  • Phone: 248-387-9091
  • Fax:
Mailing address:
  • Phone: 248-387-9091
  • Fax:

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: RYAN MERTZ
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 248-760-2701