Provider Demographics
NPI:1982894051
Name:JOHN, GIGI (PT)
Entity Type:Individual
Prefix:MR
First Name:GIGI
Middle Name:
Last Name:JOHN
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 1:17330 NORTHLAND PARK CT
Mailing Address - Street 2:STE 200A
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4325
Mailing Address - Country:US
Mailing Address - Phone:248-281-4961
Mailing Address - Fax:
Practice Address - Street 1:17330 NORTHLAND PARK CT
Practice Address - Street 2:STE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4318
Practice Address - Country:US
Practice Address - Phone:248-281-4961
Practice Address - Fax:248-415-6289
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
MI5501010680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty