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General NPI Number Information
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NPI Number | 1023809902
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Entity Type | Individual
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Provider Name | MICHAEL JORDAN PERES DPT, PT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 1187 W HURON ST
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City | WATERFORD
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State | MI
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Zip | 48328-3736
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Country | US
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Telephone | 248-977-4594
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Fax | 248-977-4597
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Provider Business Mailing Address
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Address Line | 1187 W HURON ST
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City | WATERFORD
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State | MI
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Zip | 48328-3736
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Country | US
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Telephone | 248-977-4594
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Fax | 248-977-4597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501303996
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License Number State | MI
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