Sport Track Physical Therapy and Human Performance

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SPORT TRACK PHYSICAL THERAPY AND HUMAN PERFORMANCE

Practice address

115 E Main St
Niles, MI 49120-2224

Phone

(269) 362-5242

Fax

(269) 912-5922

NPI assigned

Aug 3, 2022

Last updated

Aug 26, 2022By 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

Justin Price, DPTNPI 1679055917

Title

Owner

Phone

(269) 362-5242

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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.

• Justin Price, DPT

  • Physical Therapist
  • Niles, MI
  • NPI 1679055917
  Medicare reassignment Care Compare group NPD Authorized official
• Tom Krzysiak

  • Physical Therapist
  • Sodus, MI
  • NPI 1982258208
  Medicare reassignment Care Compare group NPD
• Lucas Flynn Brace, DPT, PT

  • Physical Therapist
  • Cambridge, MA
  • NPI 1316779135

  MI

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661472000000",
    "number": "1295462836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 CHABOT RD",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490229526",
            "telephone_number": "269-362-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E MAIN ST",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202224",
            "telephone_number": "269-362-5242",
            "fax_number": "269-912-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT TRACK PHYSICAL THERAPY AND HUMAN PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-03",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-362-5242",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1679055917",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southwestern Michigan Community Ambulance Service
• Corina Kay Spalding
• Bette Linne Spearritt, LMSW
• Cari Spencer
• Nicole Spencer
• ..Chris Narvello St Hillaire, D.D.S
• Paige Nichole Stama, PHARMD
• Linda K Stanley, M.D.
• Star of Hope Recovery House
• Jonathan Robin Steen, D.O.

• Physical Therapy Clinic/Center in Niles, MI
• Providers in Niles, 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 Aug 26, 2022; 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.