NPIMap

Organization Active NPI

Functional Innovative Therapy, LLC

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1093727802
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501012424 Issued in MI
Legal business name
FUNCTIONAL INNOVATIVE THERAPY, LLC
Practice address
3035 Hoag Ave NE
Grand Rapids, MI 49525-9632
Phone
(616) 365-9394
Fax
(616) 365-9394
NPI assigned
Aug 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Dr. Trey Joseph Kubizna, DPTNPI 1265411565
Title
Member
Phone
(616) 365-9394

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 Therapy Clinic/Center 261QP2000X 5501012424 MI Primary

Addresses

Primary practice location

3035 Hoag Ave NE
Grand Rapids, MI 49525-9632

Mailing address

3035 Hoag Ave NE
Grand Rapids, MI 49525-9632
Phone (616) 365-9394

Other names 1

  • FIT Therapy Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1093727802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 HOAG AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259632",
            "telephone_number": "616-365-9394",
            "fax_number": "616-365-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 HOAG AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259632",
            "telephone_number": "616-365-9394",
            "fax_number": "616-365-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL INNOVATIVE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KUBIZNA",
        "authorized_official_first_name": "TREY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "616-365-9394",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501012424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FIT Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.