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NPI Code Detail

MEDICARE: AMY MITTELSTAEDT MPT

MEDICARE: AMY MITTELSTAEDT MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501007529MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114197084
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MITTELSTAEDT MPT
Provider Business Mailing Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-853-7555
Fax Number : 248-853-7556
Provider Business Practice Location Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-853-7555
Fax Number : 248-853-7556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2008
Last Update Date : 08/23/2016

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