Healthcare Provider Details

I. General information

NPI: 1194231563
Provider Name (Legal Business Name): TOTAL ORTHOPEDIC PERFORMANCE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 15 MILE ROAD
STERLING HEIGHTS MI
48310
US

IV. Provider business mailing address

3522 15 MILE ROAD
STERLING HEIGHTS MI
48310
US

V. Phone/Fax

Practice location:
  • Phone: 586-883-9720
  • Fax: 586-883-9653
Mailing address:
  • Phone: 586-883-9720
  • Fax: 586-883-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501012017
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501012017
License Number StateMI

VIII. Authorized Official

Name: MR. ROSS PEARSON WALKER
Title or Position: PT/ OWNER
Credential: DPT, OMPT
Phone: 248-250-4833