Active NPI
Elina Simonen
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1639648728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501012209
- Practice address
- 630 Kenmoor Ave SE Ste 200
Grand Rapids, MI 49546-8626 - Phone
- (616) 975-6200
- Fax
- (616) 975-5400
- NPI assigned
- Nov 19, 2018
- Last updated
- Nov 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501012209 | MI | Primary |
Addresses
Primary practice location
630 Kenmoor Ave SE Ste 200
Grand Rapids, MI 49546-8626
Mailing address
630 Kenmoor Ave SE Ste 200
Grand Rapids, MI 49546-8626
Phone (616) 975-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5501012209 | Other | MI | PHYSICAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501012209 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542585600000",
"number": "1639648728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 KENMOOR AVE SE STE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468626",
"telephone_number": "616-975-6200",
"fax_number": "616-975-5400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 KENMOOR AVE SE STE 200",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468626",
"telephone_number": "616-975-6200",
"fax_number": "616-975-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONEN",
"first_name": "ELINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-11-19",
"last_updated": "2018-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501012209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY",
"identifier": "5501012209",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.