NPIMap

Organization Active NPI

Viverant, LLC

  • Physical Therapist
  • Vadnais Heights, MN
National Provider Identifier
1275055022
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
3200 Labore Rd Ste 101
Vadnais Heights, MN 55110-5189
Phone
(952) 835-4512
NPI assigned
Jul 13, 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 Dietitian 133V00000X NU
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

3200 Labore Rd Ste 101
Vadnais Heights, MN 55110-5189

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.

Locations

3200 Labore Rd
Ste 101
Vadnais Heights, MN 55110
Phone (651) 484-5369

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1275055022",
    "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": "3200 LABORE RD STE 101",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105189",
            "telephone_number": "952-835-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVERANT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIVERANT PT LLC",
        "enumeration_date": "2017-07-13",
        "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": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vadnais Heights, 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.