Terence Roderick Reuben, PT
Individual provider Active NPI Physical Therapist · East Grand Rapids, MI
NPI 1346516440 · NPPES record last updated Sep 14, 2023
Key facts
- NPI
- 1346516440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5501005616 (MI)
- Practice address
- 1540 Sherwood Ave SE
East Grand Rapids, MI 49506-5010 - Phone
- (616) 901-3831
- NPI assigned
- Mar 22, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1925 Breton Rd SE
Suite 130
Grand Rapids, MI 49506-4810
Phone (616) 901-3831
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240408000415 | MI | Practitioner - Physical Therapist in Private Practice | 3678982733 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501005616 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ptsportspro, PLLC | Physical Therapist | Current |
Accepting new patients |
Locations
1925 Breton Rd SE
Ste 130
Grand Rapids, MI 49506
Phone (616) 901-3831
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501005616 | MI | Yes |
Addresses
Primary practice location
1540 Sherwood Ave SE
East Grand Rapids, MI 49506-5010
Mailing address
1540 Sherwood Ave SE
East Grand Rapids, MI 49506-5010
Phone (616) 901-3831
Other providers in East Grand Rapids, MI
- Physiotherapy Associates Inc
- Amy S Pouillon
- Charles Przybylo
- Anna Reeve
- Restore Therapy Collective
- William George Schultz
- Christine Beth Sharp
- Kurt Ryan Sikkema
- Lori Lynn Sovis
- Spectrum Health Primary Care Partners
All providers in East Grand Rapids, MI · Physical Therapist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.