NPIMap

Organization Active NPI

Physiotherapy Associates Inc

  • Physical Therapy Clinic/Center
  • Fremont, MI
National Provider Identifier
1366549800
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PHYSIOTHERAPY ASSOCIATES INC
Practice address
1231 W Main St
Suite B
Fremont, MI 49412-1484
Phone
(231) 924-8777
Fax
(231) 924-8776
NPI assigned
Sep 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

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

Authorized official

Name
Jayne Fleck-Pool
Title
Chief Compliance Officer
Phone
(469) 467-8705

Specialties & licenses 1

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

Addresses

Primary practice location

1231 W Main St
Suite B
Fremont, MI 49412-1484

Mailing address

2300 Coit Rd
Ste 300
Plano, TX 75075-3768
Phone (469) 467-8705

Other identifiers 2

IdentifierTypeStateIssuer
4717630MedicaidMI
30609OtherMIBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030509000024 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3577470442 24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kalamazoo, MI; Muskegon, MI; Mattawan, MI; Holland, MI; Grand Rapids, MI; Battle Creek, MI; Allendale, MI

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1366549800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 COIT RD",
            "address_2": "STE 300",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750753768",
            "telephone_number": "469-467-8705",
            "fax_number": "267-321-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 W MAIN ST",
            "address_2": "SUITE B",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121484",
            "telephone_number": "231-924-8777",
            "fax_number": "231-924-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIOTHERAPY ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "FLECK-POOL",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "469-467-8705"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4717630",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "30609",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; 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.