Active NPI
Riverview Physical Therapy and Rehab,LLC
- Physical Therapist
- Port Huron, MI
National Provider Identifier
1528248036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501008202
- Legal business name
- RIVERVIEW PHYSICAL THERAPY AND REHAB,LLC
- Practice address
- 1702 Water St
Port Huron, MI 48060-4136 - Phone
- (810) 966-9102
- Fax
- (810) 966-9104
- NPI assigned
- Nov 13, 2007
- Last updated
- Apr 29, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Hargopal Tekumulla, PT
- Title
- Physical Therapist
- Phone
- (810) 966-9102
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501008202 | MI | Primary |
| Occupational Therapist | 225X00000X | 5201003768 | MI |
Addresses
Primary practice location
1702 Water St
Port Huron, MI 48060-4136
Mailing address
1702 Water St
Port Huron, MI 48060-4136
Phone (810) 966-9102
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00311258 | Other | RAILROAD MEDICARE,PT | |
| 4863011 | Medicaid | MI | |
| 080738 | Other | MI | HAP OF MI |
| 650G411130 | Other | MI | BCBS OF MICHIGAN FOR PHYSICAL THERAPY |
| 670G411150 | Other | MI | BCBS OF MICHIGAN FOR OCCUPATIONAL THERAPY |
| P00312642 | Other | RAILROAD MEDICARE ,OT, | |
| 164232 | Other | MI | GREAT LAKES HEATH PLAN |
| 48102 | Other | MI | HEALTH PLAN OF MICHIGAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
National Provider Directory
National Provider DirectoryLocations
4940 24th Ave
Fort Gratiot, MI 48059
Phone (810) 937-5444
1702 Water St
Port Huron, MI 48060
Phone (810) 966-9102
Practitioners & affiliated clinicians
Practitioners 6
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.
-
- Physical Therapist
- Port Huron, MI
- NPI 1295810851
-
- Occupational Therapist
- Port Huron, MI
- NPI 1467519553
-
- Physical Therapist
- Shelby TWP, MI
- NPI 1548707953
-
- Physical Therapist
- Port Huron, MI
- NPI 1619246626
-
- Physical Therapy Assistant
- Port Huron, MI
- NPI 1649557513
-
- Physical Therapy Assistant
- Port Huron, MI
- NPI 1063760403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194912000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1209427200000",
"number": "1528248036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 WATER ST",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480604136",
"telephone_number": "810-966-9102",
"fax_number": "810-966-9104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 WATER ST",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480604136",
"telephone_number": "810-966-9102",
"fax_number": "810-966-9104"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RIVERVIEW PHYSICAL THERAPY AND REHAB,LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-13",
"last_updated": "2008-04-29",
"status": "A",
"authorized_official_last_name": "TEKUMULLA",
"authorized_official_first_name": "HARGOPAL",
"authorized_official_title_or_position": "PHYSICAL THERAPIST",
"authorized_official_telephone_number": "810-966-9102",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501008202",
"primary": true
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201003768",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE,PT",
"identifier": "P00311258",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4863011",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAP OF MI",
"identifier": "080738",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN FOR PHYSICAL THERAPY",
"identifier": "650G411130",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN FOR OCCUPATIONAL THERAPY",
"identifier": "670G411150",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE ,OT,",
"identifier": "P00312642",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEATH PLAN",
"identifier": "164232",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLAN OF MICHIGAN",
"identifier": "48102",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Huron, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.