Provider Demographics
NPI:1790980183
Name:ORTHOSPORT PHYSICAL THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:ORTHOSPORT PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VELI PEKKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPILA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OMT, FAAOMPT
Authorized Official - Phone:734-961-9626
Mailing Address - Street 1:46615 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2336
Mailing Address - Country:US
Mailing Address - Phone:734-961-9626
Mailing Address - Fax:734-961-9627
Practice Address - Street 1:46615 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2336
Practice Address - Country:US
Practice Address - Phone:734-961-9626
Practice Address - Fax:734-961-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH24391OtherBCBSM
MIOH24391OtherBCBSM