Jdr74 Holdings, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501014355 Issued in MI

Legal business name

JDR74 HOLDINGS, LLC

Practice address

13060 S US Highway 27 Ste C4
Dewitt, MI 48820-9319

Phone

(517) 449-7173

NPI assigned

Feb 7, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Matthew Raborn, PTNPI 1477794881

Title

Physical Therapist

Phone

(517) 449-7173

Specialties & licenses 1

Addresses

Other names 1

• 5 Star Physical Therapy Specialists Other name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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

• Ryan Matthew Raborn, PT

  • Physical Therapist
  • Dewitt, MI
  • NPI 1477794881
  Medicare reassignment Care Compare group Authorized official
• Gavin Clark, PT

  • Physical Therapist
  • Dewitt, MI
  • NPI 1952271975
  Medicare reassignment Care Compare group NPD
• Maryann Howard, D.P.T.

  • Physical Therapist
  • Lansing, MI
  • NPI 1649400250
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517961600000",
    "number": "1649779331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13060 S US HIGHWAY 27 STE C4",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209319",
            "telephone_number": "517-449-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13060 S US HIGHWAY 27 STE C4",
            "city": "DEWITT",
            "state": "MI",
            "postal_code": "488209319",
            "telephone_number": "517-449-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDR74 HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-02-07",
        "status": "A",
        "authorized_official_last_name": "RABORN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "517-449-7173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501014355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "5 Star Physical Therapy Specialists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• J&W Ventures, Inc.
• Jack K Martin DC PLLC
• Jenna Marie Jaissle
• Nicole Janes, OTR/L
• Janis M. Rygwelski MD, PLLC
• John M. Hobbs, Jr., M.D., P.C.
• Marcyanna Jorae, RPH
• Kairos Counseling and Wellness
• Kadijah Grace Kalo, PHARMD
• Jennifer Kanouse

• Physical Therapist in Dewitt, MI
• Providers in Dewitt, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2018; 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.