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General NPI Number Information
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NPI Number | 1194231563
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Entity Type | Organization
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Legal Business Name | TOTAL ORTHOPEDIC PERFORMANCE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 3522 15 MILE ROAD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310
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Country | US
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Telephone | 586-883-9720
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Fax | 586-883-9653
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Provider Business Mailing Address
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Address Line | 3522 15 MILE ROAD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310
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Country | US
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Telephone | 586-883-9720
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Fax | 586-883-9653
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Authorized Official
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Title or Position | PT/ OWNER
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Name | MR. ROSS PEARSON WALKER
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Credential | DPT, OMPT
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Telephone | 248-250-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 5501012017
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501012017
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License Number State | MI
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