NPIMap

Organization Active NPI

Jackson's Preferred Rehab

  • Physical Therapist
  • Grass Lake, MI
National Provider Identifier
1609998954
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501007396 Issued in MI
Legal business name
JACKSON'S PREFERRED REHAB
Practice address
110 E Michigan Ave
Grass Lake, MI 49240-9680
Phone
(517) 745-3161
NPI assigned
Apr 6, 2007
Last updated
May 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Authorized official

Name
Mrs. Karthyayani Kunchappa, PT
Title
PT
Phone
(517) 745-3161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501007396 MI Primary

Addresses

Primary practice location

110 E Michigan Ave
Grass Lake, MI 49240-9680

Mailing address

110 E. Michigan Ave
Grass Lake, MI 49240
Phone (517) 522-4828

Other identifiers 1

IdentifierTypeStateIssuer
65C807050OtherMIBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1609998954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E. MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "49240",
            "telephone_number": "517-522-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E MICHIGAN AVE",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492409680",
            "telephone_number": "517-745-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON'S PREFERRED REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "KUNCHAPPA",
        "authorized_official_first_name": "KARTHYAYANI",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "517-745-3161",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501007396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "65C807050",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; 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.