NPIMap

Organization Active NPI

Viverant, LLC

  • Physical Therapist
  • Eagan, MN
National Provider Identifier
1295257491
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
3365 Central Park Village Dr Ste 100
Eagan, MN 55121-7707
Phone
(952) 835-4512
Fax
(952) 835-4512
NPI assigned
Jul 10, 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, Operations
Phone
(208) 854-7854

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

3365 Central Park Village Dr Ste 100
Eagan, MN 55121-7707

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.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1295257491",
    "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": "3365 CENTRAL PARK VILLAGE DR STE 100",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "952-835-4512",
            "fax_number": "952-835-4512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVERANT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VIVERANT PT LLC",
        "enumeration_date": "2017-07-10",
        "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, OPERATIONS",
        "authorized_official_telephone_number": "208-854-7854"
    },
    "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 Eagan, 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.