Worksport Rehabilitation Service

Primary specialty

SpecialistTaxonomy code 174400000X

License

05002570A Issued in IN

Legal business name

WORKSPORT REHABILITATION SERVICE

Practice address

2338 N US Highway 35
La Porte, IN 46350-8380

Phone

(219) 325-0060

Fax

(219) 325-9919

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Randall Brooks, RPT

Title

President/Owner

Phone

(219) 325-0060

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287360000000",
    "number": "1639270010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2338 N US HIGHWAY 35",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463508380",
            "telephone_number": "219-325-0060",
            "fax_number": "219-325-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2338 N US HIGHWAY 35",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463508380",
            "telephone_number": "219-325-0060",
            "fax_number": "219-325-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORKSPORT REHABILITATION SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2010-10-18",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "219-325-0060",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IN",
            "license": "05002570A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200240530A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200891110B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS PROVIDER NUMBER",
            "identifier": "000000093552",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in La Porte, IN
• Providers in La Porte, IN by specialty
• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; 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.