NPIMap

Organization Active NPI

Independence Rehab LLC

  • Physical Therapy Clinic/Center
  • Grandville, MI
National Provider Identifier
1427184589
Registry record updated Feb 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501005678 Issued in MI
Legal business name
INDEPENDENCE REHAB LLC
Practice address
3753 Basswood Dr SW
Grandville, MI 49418-2003
Phone
(616) 340-6407
Fax
(616) 301-2882
NPI assigned
Feb 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2008

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

Authorized official

Name
Mr. Kirk Christopher Randall, P.T.NPI 1235172826
Title
Owner
Phone
(616) 340-6407

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 Therapy Clinic/Center 261QP2000X 5501005678 MI Primary

Addresses

Primary practice location

3753 Basswood Dr SW
Grandville, MI 49418-2003

Mailing address

3753 Basswood Dr SW
Grandville, MI 49418-2003
Phone (616) 340-6407

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1172361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1427184589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3753 BASSWOOD DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182003",
            "telephone_number": "616-340-6407",
            "fax_number": "616-301-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3753 BASSWOOD DR SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182003",
            "telephone_number": "616-340-6407",
            "fax_number": "616-301-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-25",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-340-6407",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501005678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.