Great Northern Rehab P C

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

GREAT NORTHERN REHAB P C

Practice address

1310 E Cloverland Dr
Ironwood, MI 49938-1606

Phone

(906) 932-4200

Fax

(906) 932-4201

NPI assigned

May 20, 2011

Last updated

Apr 30, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Richard W Shutes

Title

Ceo/President

Phone

(352) 732-8868

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 7

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.

• Shawn Edyvean, PT

  • Physical Therapist
  • Watersmeet, MI
  • NPI 1285824581
  Medicare reassignment NPD
• Dana Lynn Leannah, MOT, OTR/L

  • Occupational Therapist
  • Ironwood, MI
  • NPI 1245504562
  Medicare reassignment NPD
• Rebecca Lynn Mika, OTR

  • Occupational Therapist
  • Ironwood, MI
  • NPI 1396811121
  NPD
• Kathryn Ann Fredianelli, PTA

  • Physical Therapy Assistant
  • Ironwood, MI
  • NPI 1770876286
  NPD (past)
• Monica McCarter

  • Physical Therapist
  • Ironwood, MI
  • NPI 1912290339
  NPD (past)
• Mathew Phillip Sommer, PTA

  • Physical Therapy Assistant
  • Ironwood, MI
  • NPI 1902166713
  NPD (past)
• Monica Therese Kutz, OTR

  • Occupational Therapist
  • Ashland, WI
  • NPI 1265724116
  NPD (past)

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

{
    "created_epoch": "1305849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1386937530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 SE MARICAMP RD",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344715582",
            "telephone_number": "352-732-8868",
            "fax_number": "352-732-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 E CLOVERLAND DR",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499381606",
            "telephone_number": "906-932-4200",
            "fax_number": "906-932-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT NORTHERN REHAB P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-20",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "SHUTES",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "352-732-8868",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Leah Fiorucci, LMSW
• Kathryn Ann Fredianelli, PTA
• Wes L Frisbey, O.D.
• Sarah Gille, CST/CSFA
• Great Lakes Recovery Centers
• Stanley Weir Gresham, DDS
• Jane Gruenke, R.PH.
• Allison Harr, APRN CNM
• Susanna Lee Harris
• Billie Jo Hellen, M.S.W.

• Physical Therapist in Ironwood, MI
• Providers in Ironwood, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2012; 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.