Spine Dynamics Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501006157 Issued in MI

Legal business name

SPINE DYNAMICS PHYSICAL THERAPY LLC

Practice address

660 Cascade West Pkwy SE Ste 25
Grand Rapids, MI 49546-2142

Phone

(616) 229-4500

Fax

(616) 228-9828

NPI assigned

Dec 7, 2016

Organization subpart

No

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

Authorized official

Name

Alicia Canos-Torres, PTNPI 1700832805

Title

Physical Therapist

Phone

(616) 229-4500

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Canos-Torres, PT, MOMT

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1700832805
  Medicare reassignment NPD Authorized official
• Brad A Johanson, DPT

  • Orthopedic Physical Therapist
  • Grand Rapids, MI
  • NPI 1407289622
  Medicare reassignment NPD

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1487198677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 CASCADE WEST PKWY SE STE 25",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462142",
            "telephone_number": "616-229-4500",
            "fax_number": "616-228-9828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 CASCADE WEST PKWY SE STE 25",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462142",
            "telephone_number": "616-229-4500",
            "fax_number": "616-228-9828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE DYNAMICS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "CANOS-TORRES",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "616-229-4500",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501006157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5501006157",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700832805",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Spieker, LPC
• Eleanor Spielmaker
• Jane Lucille Spies-Wert, PH.D.
• Shaun Spina
• Spine & Sport Physical Therapy Services Inc.
• Jessica Spitters
• Anna Rose Spitzley
• Nathan Spitzley
• Leanne Dena Spoelma, PA-C
• Jessica Spohn

• Physical Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.