MEDICARE: DR. JOSEPH MICHAEL LIBERATI PT, DPT

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	5501018917	MI

General Provider Information

NPI Number	:	1942770953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MICHAEL LIBERATI PT, DPT

Provider Business Mailing Address
First Line	:	3040 YORKSHIRE DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9244
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 W HIGH ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3028
Country	:	US
Telephone Number	:	989-772-0258
Fax Number	:

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

Provider Enumeration Date	:	12/03/2018
Last Update Date	:	12/03/2018

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