MEDICARE: THERA-PEDS

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
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1508202151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERA-PEDS

Provider Business Mailing Address
First Line	:	16137 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	586-566-0326
Fax Number	:	586-566-0573

Provider Business Practice Location Address
First Line	:	16137 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	586-566-0326
Fax Number	:	586-566-0573

Authorized Official
Title or Position	:	OWNER
Name	:	CATHERINE KELLEY
Credential	:
Telephone Number	:	586-212-3137

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	03/24/2026

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Directions to “THERA-PEDS ” Practice Location

Language	Start Address	Practice Location

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