Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Theresa Fetter, MPT

Individual provider Physical Therapist · NPI 1831690429

Theresa Fetter, MPT is registered under Physical Therapist in Private Practice in Saint Clair Shores, Michigan. Qualified in 2004, 22 years ago. Practices with Form Physical Therapy LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
22
Licensed in
MI
In the registry since
2018
What do these letters mean?
MPT — Master of Physical Therapy
The master's-level physical therapy degree awarded before the DPT became standard.

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Practice location Address checks out

23715 Little Mack Ave Ste 200
Saint Clair Shores, MI 48080-1181
Phone: (586) 447-4070
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 5501011984 (MI)

Record details

NPI number1831690429
Entity typeIndividual (Type 1)
GenderFemale
Credentials MPT
Sole proprietorNo
NPI enumeratedFebruary 28, 2018
Last updated in NPPESFebruary 28, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Form Physical Therapy Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Colleagues at Form Physical Therapy LLC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice.

Other providers in Saint Clair Shores