Individual provider Active NPI

Will Knoll

  • Physical Therapist
  • Portage, MI
National Provider Identifier
1033802459
Registry record updated May 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501302579 Issued in MI
Practice address
6016 Lovers LN Ste 3
Portage, MI 49002-3050
Phone
(269) 329-0934
NPI assigned
May 31, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501302579 MI Primary

Addresses

Primary practice location

6016 Lovers LN Ste 3
Portage, MI 49002-3050

Mailing address

625 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2395

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230623002671 MI Practitioner - Physical Therapist in Private Practice 1557729472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Physical Therapy Group LLCGroup PAC ID 8921065707, 35 clinicians

Practice addresses (Care Compare)

6016 Lovers LN
Suite 3
Portage, MI 49002-3050
Phone (269) 329-0934

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physical Therapy Group LLC Physical Therapist CurrentSince Jun 5, 2023 Accepting new patients

Locations

625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546

601 Michigan Ave
Ste 220
Holland, MI 49423
Phone (616) 355-4284

6016 Lovers Ln
Ste 3
Portage, MI 49002
Phone (269) 248-1946

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685491200000",
    "number": "1033802459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 KENMOOR AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6016 LOVERS LN STE 3",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023050",
            "telephone_number": "269-329-0934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOLL",
        "first_name": "WILL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2023-05-31",
        "certification_date": "2023-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501302579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.