MEDICARE: MR. PAUL ANTHONY CARLESIMO MPT, OMPT

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	225100000X	Physical Therapist	5501011583	MI

General Provider Information

NPI Number	:	1851497895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL ANTHONY CARLESIMO MPT, OMPT

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-416-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 METRO PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4103
Country	:	US
Telephone Number	:	586-276-9776
Fax Number	:	586-354-2480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/22/2019

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