Vivid Rehab Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501014578 Issued in MI

Legal business name

VIVID REHAB INC

Practice address

12830 Ford Rd Ste C
Dearborn, MI 48126-3350

Phone

(313) 406-3832

Fax

(313) 406-3716

NPI assigned

Mar 5, 2018

Last updated

Mar 5, 2018By 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

Lawrence Atat

Title

Owner

Phone

(313) 707-2686

Specialties & licenses 1

Addresses

Other names 1

• VIVID REHAB INC Former legal business name

Locations

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

{
    "created_epoch": "1520208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520208000000",
    "number": "1245732361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12830 FORD RD STE C",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263350",
            "telephone_number": "313-406-3832",
            "fax_number": "313-406-3716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12830 FORD RD STE C",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481263350",
            "telephone_number": "313-406-3832",
            "fax_number": "313-406-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-05",
        "last_updated": "2018-03-05",
        "status": "A",
        "authorized_official_last_name": "ATAT",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-707-2686"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501014578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIVID REHAB INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nickolas Simon Vinokurov
• Kaitlyn Virga
• Natalie Jean Virga
• Vital Home Care LLC
• Giovanni Vitale II, LLP
• Nicole Lyn Von Seggern, LLMSW
• Brian Jeffrey Vosko, M.S., PA-C
• Theresa Palma Voyles, O.D.
• Ling Vuong
• W.J. Ringold M.D.P.C.

• Physical Therapy Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2018; 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.