NPIMap

Organization Active NPI

Dery Physical Therapy Services, PC

  • Physical Therapy Clinic/Center
  • Lowell, MI
National Provider Identifier
1326184151
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
DERY PHYSICAL THERAPY SERVICES, PC
Practice address
901 W Main St
Suite a
Lowell, MI 49331-1581
Phone
(616) 897-7055
Fax
(616) 897-7366
NPI assigned
Jan 29, 2007
Last updated
Feb 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Authorized official

Name
Mr. Casimir A Kilyanek, PTNPI 1396881132
Title
President
Phone
(616) 897-7055

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X MI Primary

Addresses

Primary practice location

901 W Main St
Suite a
Lowell, MI 49331-1581

Mailing address

901 W Main St
Suite a
Lowell, MI 49331-1581
Phone (616) 897-7055

Other identifiers 1

IdentifierTypeStateIssuer
30732OtherMIBCSBM NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326184151. Details of each certification follow.

  • CCN 236751 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236751

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Dery Physical Therapy Services, PC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Sep 3, 1998
Last certification
Nov 26, 2019
Ownership / control type
Proprietary
Facility address
901 W Main St, Suite A
Lowell, MI 49331

National Provider Directory

National Provider Directory

Locations

901 W Main St
Ste A
Lowell, MI 49331
Phone (616) 897-7055

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1326184151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST",
            "address_2": "SUITE A",
            "city": "LOWELL",
            "state": "MI",
            "postal_code": "493311581",
            "telephone_number": "616-897-7055",
            "fax_number": "616-897-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST",
            "address_2": "SUITE A",
            "city": "LOWELL",
            "state": "MI",
            "postal_code": "493311581",
            "telephone_number": "616-897-7055",
            "fax_number": "616-897-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERY PHYSICAL THERAPY SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2017-02-03",
        "status": "A",
        "authorized_official_last_name": "KILYANEK",
        "authorized_official_first_name": "CASIMIR",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-897-7055",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCSBM NUMBER",
            "identifier": "30732",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MI

Sources for this page

Verify at the official NPI Registry.