NPIMap

Organization Active NPI

Premier Rehabilitation

  • Physical Therapist
  • Holt, MI
National Provider Identifier
1306244066
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIER REHABILITATION
Practice address
2380 Cedar St
Suite 203
Holt, MI 48842-2143
Phone
(517) 709-4677
Fax
(517) 798-5667
NPI assigned
Dec 11, 2014
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Tyler WilsonNPI 1831458413
Title
Member/Physical Therapist
Phone
(517) 709-4677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

2380 Cedar St
Suite 203
Holt, MI 48842-2143

Mailing address

2380 Cedar St
Suite 203
Holt, MI 48842-2143
Phone (517) 709-4677

Other practice location 1

3315 E Michigan Ave Ste 6
Lansing, MI 48912-4600
Phone (517) 709-4677

Other practice location 2

615 S Clinton St
Grand Ledge, MI 48837-2355
Phone (517) 709-4677

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150511002193 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698094795 Receives reassigned benefits from 22 practitioners
Practice locations: Grand Ledge, MI; Haslett, MI; Holt, MI; Howell, MI; Lansing, MI

National Provider Directory

National Provider Directory

Locations

615 S Clinton St
Grand Ledge, MI 48837
Phone (517) 709-4677

615 S Clinton St
Ste 203
Grand Ledge, MI 48837

1630 Haslett Rd
Ste 4
Haslett, MI 48840
Phone 51770946774

2380 Cedar St
Ste 203
Holt, MI 48842
Phone (517) 709-4677

751 S Latson Rd
Apt C
Howell, MI 48843
Phone (517) 709-4677

3315 E Michigan Ave
Ste 6
Lansing, MI 48912
Phone (517) 709-4677

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1306244066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 CEDAR ST",
            "address_2": "SUITE 203",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488422143",
            "telephone_number": "517-709-4677",
            "fax_number": "517-798-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 CEDAR ST",
            "address_2": "SUITE 203",
            "city": "HOLT",
            "state": "MI",
            "postal_code": "488422143",
            "telephone_number": "517-709-4677",
            "fax_number": "517-798-5667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3315 E Michigan Ave Ste 6",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489124600",
            "country_code": "US",
            "telephone_number": "517-709-4677",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "615 S Clinton St",
            "address_purpose": "LOCATION",
            "city": "Grand Ledge",
            "state": "MI",
            "postal_code": "488372355",
            "country_code": "US",
            "telephone_number": "517-709-4677",
            "fax_number": "517-798-5667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREMIER REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "MEMBER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "517-709-4677"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holt, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.