NPIMap

Organization Active NPI

Orthopedic Physical Therapy Specialist LLC

  • Physical Therapy Clinic/Center
  • South Haven, MI
National Provider Identifier
1407058209
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501011004 Issued in MI
Legal business name
ORTHOPEDIC PHYSICAL THERAPY SPECIALIST LLC
Practice address
02957 73Rd St
South Haven, MI 49090-9364
Phone
(269) 637-9099
Fax
(269) 637-9224
NPI assigned
Jun 4, 2007
Last updated
Mar 1, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

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

Authorized official

Name
Mr. Paul Frederick, PTNPI 1790881290
Title
Owner
Phone
(269) 637-9099

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 5501011004 MI Primary

Addresses

Primary practice location

02957 73Rd St
South Haven, MI 49090-9364

Mailing address

02957 73Rd St
South Haven, MI 49090-9364
Phone (269) 637-9099

Other identifiers 1

IdentifierTypeStateIssuer
4800853-10MedicaidMI

National Provider Directory

National Provider Directory

Locations

02957 73rd St
South Haven, MI 49090
Phone (269) 637-9099

Practitioners & affiliated clinicians

Practitioners 2

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": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1407058209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "02957 73RD ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909364",
            "telephone_number": "269-637-9099",
            "fax_number": "269-637-9224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "02957 73RD ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909364",
            "telephone_number": "269-637-9099",
            "fax_number": "269-637-9224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC PHYSICAL THERAPY SPECIALIST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "FREDERICK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-637-9099",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501011004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4800853-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; 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.