Vanita Upendra Koepke, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501016335 Issued in MI

Practice address

26025 Lahser Rd
Southfield, MI 48033

Phone

(248) 663-2192

Fax

(248) 663-1901

NPI assigned

Feb 21, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Vanita Upendra Shukla Former name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pryde Physical Therapy PLLCGroup PAC ID 2860801008, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pryde Physical Therapy PLLC

  • Physical Therapist
  • Canton, MI
  • NPI 1912503830
  Medicare reassignment Care Compare group
• Back to You Rehab PLLC

  • Physical Therapist
  • Royal Oak, MI
  • NPI 1386124378
  NPD (past)

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1679073191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33900 HARPER AVE STE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480354258",
            "telephone_number": "586-350-2644",
            "fax_number": "586-541-3735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26025 LAHSER RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48033",
            "telephone_number": "248-663-2192",
            "fax_number": "248-663-1901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27652 Franklin Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480348200",
            "country_code": "US",
            "telephone_number": "248-359-8700",
            "fax_number": "248-359-8703",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEPKE",
        "first_name": "VANITA",
        "middle_name": "UPENDRA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-21",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501016335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VANITA",
            "last_name": "SHUKLA",
            "middle_name": "UPENDRA",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Angela Knopek, COTAL
• Knowledge of Self
• Kochs Orthotic and Prosthetics
• Manjuli Kodagoda, M.D.
• Elise Koelsch
• Tina Koester, D.O.
• James Douglas Kohler, D.D.S.
• Laura Sacks Kohn, MA LPC
• Selma Kokic
• Victoria Kolatski

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.