NPIMap

Organization Active NPI

Mountain Town Rehab, Inc

  • Physical Therapist
  • Mt Pleasant, MI
National Provider Identifier
1003025263
Registry record updated Jun 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501005383 Issued in MI
Legal business name
MOUNTAIN TOWN REHAB, INC
Practice address
1106 W High St
Mt Pleasant, MI 48858-2242
Phone
(989) 779-2920
Fax
(989) 772-9424
NPI assigned
May 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Thomas Stansberry, PTNPI 1689731119
Title
Owner
Phone
(989) 779-2920

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5501005383 MI Primary

Addresses

Primary practice location

1106 W High St
Mt Pleasant, MI 48858-2242

Mailing address

1106 W High St
Mt Pleasant, MI 48858-2242
Phone (989) 779-2920

Other identifiers 1

IdentifierTypeStateIssuer
650C700040OtherMIBLUE CROSS BLUE SHEILD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040601000627 MI Part B Supplier - Clinic/Group Practice 8729069109 Receives reassigned benefits from 5 practitioners
Practice locations: Mt Pleasant, MI

National Provider Directory

National Provider Directory

Locations

1106 W High St
Mt Pleasant, MI 48858
Phone (989) 779-2920

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214006400000",
    "number": "1003025263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 W HIGH ST",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488582242",
            "telephone_number": "989-779-2920",
            "fax_number": "989-772-9424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 W HIGH ST",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488582242",
            "telephone_number": "989-779-2920",
            "fax_number": "989-772-9424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN TOWN REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-06-21",
        "status": "A",
        "authorized_official_last_name": "STANSBERRY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-779-2920",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501005383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "650C700040",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.