NPIMap

Organization Active NPI

Viverant, LLC

  • Physical Therapist
  • Edina, MN
National Provider Identifier
1104343300
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
VIVERANT, LLC
Practice address
5400 France Ave S
Edina, MN 55410-2356
Phone
(952) 835-4512
NPI assigned
Aug 28, 2017
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
VIVERANT PT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

Name
Michael Lanham
Title
Director
Phone
(952) 835-4512

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133V00000X
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

5400 France Ave S
Edina, MN 55410-2356

Mailing address

1769 Lexington Ave N # 286
Roseville, MN 55113-6522
Phone (952) 835-4512

National Provider Directory

National Provider Directory
Tax ID family
Viverant LLC12 organizations share this tax ID, including this one
Part of
Viverant PT LLC

Other organizations with this tax ID 11

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1104343300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1769 LEXINGTON AVE N # 286",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136522",
            "telephone_number": "952-835-4512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 FRANCE AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554102356",
            "telephone_number": "952-835-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVERANT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIVERANT PT LLC",
        "enumeration_date": "2017-08-28",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "LANHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "952-835-4512"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2020; 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.