NPIMap

Organization Active NPI

Great Lakes Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • Spirit Lake, IA
National Provider Identifier
1255646709
Registry record updated Aug 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
00868 Issued in IA
Legal business name
GREAT LAKES PHYSICAL THERAPY, PC
Practice address
3301 Bergquist Ave
Spirit Lake, IA 51360-7268
Phone
(712) 336-2722
NPI assigned
Aug 9, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2010

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

Authorized official

Name
David Jon Halland, PT
Title
Physical Therapist
Phone
(712) 320-2722

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 00807 IA
Physical Therapy Clinic/Center 261QP2000X 01261 IA
Physical Therapy Clinic/Center 261QP2000X 01929 IA
Physical Therapy Clinic/Center 261QP2000X 03253 IA
Physical Therapy Clinic/Center 261QP2000X 00868 IA Primary
Rehabilitation Clinic/Center 261QR0400X 01681 IA
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 055168 IA

Addresses

Primary practice location

3301 Bergquist Ave
Spirit Lake, IA 51360-7268

Mailing address

3301 Bergquist Aveue
Spirit Lake, IA 51360-7268

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281312000000",
    "number": "1255646709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 BERGQUIST AVEUE",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513607268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 BERGQUIST AVE",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513607268",
            "telephone_number": "712-336-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-09",
        "last_updated": "2010-08-09",
        "status": "A",
        "authorized_official_last_name": "HALLAND",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "712-320-2722",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "00807",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "01261",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "01929",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "03253",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "00868",
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IA",
            "license": "01681",
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "IA",
            "license": "055168",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spirit Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; 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.