NPIMap

Organization Active NPI

Leelanau Physical Therapy, PC

Doing business as Leelanau Physical Therapy

  • Physical Therapist
  • Suttons Bay, MI
National Provider Identifier
1295092658
Registry record updated Apr 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501004763 Issued in MI
Legal business name
LEELANAU PHYSICAL THERAPY, PC
Doing business as
Leelanau Physical Therapy
Practice address
1381 S West Bay Shore Dr
Suttons Bay, MI 49682-9498
Phone
(231) 218-7056
Fax
(231) 933-9320
NPI assigned
Apr 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2012

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

Authorized official

Name
Mr. Aaron Lee Noble
Title
President
Phone
(231) 357-1985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5501004763 MI Primary

Addresses

Primary practice location

1381 S West Bay Shore Dr
Suttons Bay, MI 49682-9498

Mailing address

9578 Woodys Run
Traverse City, MI 49684-7910
Phone (231) 933-9320

Other names 1

  • Leelanau Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120719000109 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557527561 Receives reassigned benefits from 19 practitioners
Practice locations: Traverse City, MI

National Provider Directory

National Provider Directory

Locations

1878 S West Bay Shore Dr
Suttons Bay, MI 49682

1381 SW Bayshore Dr
Suttons Bay, MI 49682
Phone (231) 271-0374

5901 Shugart Ln
Traverse City, MI 49684
Phone (231) 943-1655

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1295092658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9578 WOODYS RUN",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847910",
            "telephone_number": "231-933-9320",
            "fax_number": "231-933-9320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 S WEST BAY SHORE DR",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829498",
            "telephone_number": "231-218-7056",
            "fax_number": "231-933-9320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEELANAU PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-23",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-357-1985",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leelanau Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suttons Bay, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.