Vivid Performance Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

VIVID PERFORMANCE PHYSICAL THERAPY

Practice address

1517 15TH Street
Northlake, TX 76226

Phone

(269) 377-5117

NPI assigned

Nov 13, 2019

Last updated

Nov 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Spencer Andrew Cole, PT,DPT,OCS,CSCS

Title

Owner

Phone

(269) 377-5117

Specialties & licenses 3

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1573603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573603200000",
    "number": "1083259139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1517 15TH STREET",
            "city": "NORTHLAKE",
            "state": "TX",
            "postal_code": "76226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1517 15TH STREET",
            "city": "NORTHLAKE",
            "state": "TX",
            "postal_code": "76226",
            "telephone_number": "269-377-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID PERFORMANCE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-13",
        "last_updated": "2019-11-13",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-377-5117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT,DPT,OCS,CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pteverywhere.com",
            "affiliation": "N",
            "endpointDescription": "This is a cloud based EMR system that is HIPAA compliant and secure",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1517 15th Street",
            "city": "Northlake",
            "state": "TX",
            "country_code": "US",
            "postal_code": "76226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Northlake, TX
• Providers in Northlake, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.