Provider Demographics
NPI:1104595321
Name:GUSTITUS, ROBERT LEE (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:GUSTITUS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50200 DENNIS CT
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2021
Mailing Address - Country:US
Mailing Address - Phone:248-229-5000
Mailing Address - Fax:
Practice Address - Street 1:50200 DENNIS CT
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2021
Practice Address - Country:US
Practice Address - Phone:248-229-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
55010202342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic