Initium Physical Therapy and Sports Performance LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

INITIUM PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC

Practice address

2506 S State St
Saint Joseph, MI 49085-1916

Phone

(269) 470-5831

NPI assigned

Feb 2, 2022

Last updated

Feb 2, 2022By 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

Trevor Carr, DPTNPI 1124257423

Title

Physical Therapist

Phone

(269) 470-5831

Specialties & licenses 1

Addresses

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.

• Trevor Carr, PT

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1124257423
  NPD Authorized official

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

{
    "created_epoch": "1643760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1144973769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 S STATE ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851916",
            "telephone_number": "269-470-5831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2506 S STATE ST",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851916",
            "telephone_number": "269-470-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INITIUM PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-02",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "269-470-5831",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristi Lynn Huttenga, R.PH.
• Matthew Konen Hysell, M.D.
• Roman Hyszczak, MD
• Allyse Marie Ide, TLLP
• Iliff Chiropractic
• Innovative Senior Care Home Health of Holland LLC (Brookdale Home Health Holland)
• Amena Iqbal
• Ismail B. Sendi, MD PC (New Oakland Family Centers)
• Kevin Rojeh Ismair, D.O.
• Kaitlyn Jackson

• Physical Therapist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2022; 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.