Provider Demographics
NPI:1346306297
Name:PINTAR, ANNE MARGARET (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARGARET
Last Name:PINTAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARGARET
Other - Last Name:GROGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17070 W 12 MILE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2116
Mailing Address - Country:US
Mailing Address - Phone:248-483-3990
Mailing Address - Fax:248-750-0692
Practice Address - Street 1:17070 W 12 MILE RD
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2116
Practice Address - Country:US
Practice Address - Phone:248-483-3990
Practice Address - Fax:248-750-0692
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI230165Medicare ID - Type UnspecifiedPHYSICAL THERAPY ST JOHN
MI6023003Medicare PIN