MEDICARE: MATRX HEALTH & FITNESS, LLC

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	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	2251N0400X	Neurology Physical Therapist	5501015621	MI

General Provider Information

NPI Number	:	1598255960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRX HEALTH & FITNESS, LLC

Provider Business Mailing Address
First Line	:	16145 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	586-232-3644
Fax Number	:	248-579-0197

Provider Business Practice Location Address
First Line	:	16145 LEONE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-4063
Country	:	US
Telephone Number	:	586-232-3644
Fax Number	:	248-579-0197

Authorized Official
Title or Position	:	CEO
Name	:	DR. KRYSTINA NICOLE MILLER
Credential	:	PT, DPT, ATP
Telephone Number	:	586-232-3644

Provider Enumeration Date	:	05/11/2018
Last Update Date	:	05/22/2025

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Directions to “MATRX HEALTH & FITNESS, LLC ” Practice Location

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