Active NPI
Lake Foco, DPT
- Physical Therapist
- Grand Haven, MI
National Provider Identifier
1407630643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 17272 Robbins Rd Ste 102
Grand Haven, MI 49417-2677 - Phone
- (616) 256-8670
- NPI assigned
- Aug 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
17272 Robbins Rd Ste 102
Grand Haven, MI 49417-2677
Mailing address
PO Box 30516
Dept 5300
Lansing, MI 48909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5501302860 | Other | MI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713744000000",
"number": "1407630643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30516",
"address_2": "DEPT 5300",
"city": "LANSING",
"state": "MI",
"postal_code": "48909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17272 ROBBINS RD STE 102",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494172677",
"telephone_number": "616-256-8670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOCO",
"first_name": "LAKE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-21",
"last_updated": "2024-04-22",
"certification_date": "2024-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "5501302860",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.