NPIMap

Organization Active NPI

Northsport Physical Therapy & Rehabilitation PC

  • Physical Therapist
  • Fairview, MI
National Provider Identifier
1003253170
Registry record updated Nov 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NORTHSPORT PHYSICAL THERAPY & REHABILITATION PC
Practice address
1968 E Miller Rd
Fairview, MI 48621-8717
Phone
(989) 848-2525
Fax
(989) 848-2999
NPI assigned
May 30, 2013
Last updated
Nov 5, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2013

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

Authorized official

Name
Lisa C. Petrie, PTNPI 1699082545
Title
President/PT
Phone
(989) 848-2525

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 Primary

Addresses

Primary practice location

1968 E Miller Rd
Fairview, MI 48621-8717

Mailing address

1622 Dickerson Rd
Gaylord, MI 49735-9206
Phone (989) 848-2525

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131212000282 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294902508 Receives reassigned benefits from 3 practitioners
Practice locations: Fairview, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northsport Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383609600000",
    "number": "1003253170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 DICKERSON RD",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359206",
            "telephone_number": "989-848-2525",
            "fax_number": "989-848-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 E MILLER RD",
            "city": "FAIRVIEW",
            "state": "MI",
            "postal_code": "486218717",
            "telephone_number": "989-848-2525",
            "fax_number": "989-848-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSPORT PHYSICAL THERAPY & REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-11-05",
        "status": "A",
        "authorized_official_last_name": "PETRIE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT/PT",
        "authorized_official_telephone_number": "989-848-2525",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; 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.