NPIMap

Organization Active NPI

Lakeshore Rehabilitation Center PC

  • Physical Therapist
  • Muskegon, MI
National Provider Identifier
1376604389
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501007594 Issued in MI
Legal business name
LAKESHORE REHABILITATION CENTER PC
Practice address
137 E Laketon Ave
Muskegon, MI 49442-5507
Phone
(231) 728-4102
Fax
(231) 722-0800
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jimmie J Anthony, PTNPI 1780878561
Title
Owner Physical Therapist
Phone
(231) 728-4102

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5501007594 MI Primary

Addresses

Primary practice location

137 E Laketon Ave
Muskegon, MI 49442-5507

Mailing address

137 E Laketon Ave
Muskegon, MI 49442-5507
Phone (231) 728-4102

Other names 1

  • West Michigan Sports Medicine Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

302 S Beechtree St
Grand Haven, MI 49417
Phone (616) 846-5000

949 W Broadway Ave
Muskegon, MI 49441
Phone (231) 728-4102

4131 W Loomis Rd
Ste 200
Milwaukee, WI 53221
Phone (414) 281-5151

Practitioners & affiliated clinicians

Practitioners 5

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376604389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 E LAKETON AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425507",
            "telephone_number": "231-728-4102",
            "fax_number": "231-722-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 E LAKETON AVE",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494425507",
            "telephone_number": "231-728-4102",
            "fax_number": "231-722-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE REHABILITATION CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANTHONY",
        "authorized_official_first_name": "JIMMIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "231-728-4102",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501007594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Michigan Sports Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.