Provider Demographics
NPI:1932531761
Name:JOSE, TITO (PT)
Entity Type:Individual
Prefix:MR
First Name:TITO
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S LOVINGTON DR
Mailing Address - Street 2:APT 103
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-4333
Mailing Address - Country:US
Mailing Address - Phone:313-312-5754
Mailing Address - Fax:
Practice Address - Street 1:37463 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1007
Practice Address - Country:US
Practice Address - Phone:313-312-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist