Provider Demographics
NPI:1023809902
Name:PERES, MICHAEL JORDAN (DPT, PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JORDAN
Last Name:PERES
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3736
Mailing Address - Country:US
Mailing Address - Phone:248-977-4594
Mailing Address - Fax:248-977-4597
Practice Address - Street 1:1187 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3736
Practice Address - Country:US
Practice Address - Phone:248-977-4594
Practice Address - Fax:248-977-4597
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist