NPIMap

Organization Active NPI

Orthosport Physical Therapy and Athletic Rehabilitation Inc.

  • Orthopedic Physical Therapist
  • Petoskey, MI
National Provider Identifier
1710995246
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
5501008449 Issued in MI
Legal business name
ORTHOSPORT PHYSICAL THERAPY AND ATHLETIC REHABILITATION INC.
Practice address
2230 E Mitchell Rd
Suite B
Petoskey, MI 49770-6601
Phone
(231) 348-1011
Fax
(231) 348-6998
NPI assigned
Aug 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Alan August Budnick, MPT,OCSNPI 1871508465
Title
Owner/President
Phone
(231) 348-1011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 5501008449 MI Primary

Addresses

Primary practice location

2230 E Mitchell Rd
Suite B
Petoskey, MI 49770-6601

Mailing address

2230 E Mitchell Rd
Suite B
Petoskey, MI 49770-6601
Phone (231) 348-1011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607000586 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0547203952 Receives reassigned benefits from 10 practitioners
Practice locations: Harbor Springs, MI; Indian River, MI; Petoskey, MI

National Provider Directory

National Provider Directory

Locations

8875 M 119
Harbor Springs, MI 49740
Phone (231) 881-9000

351 S Straits Hwy
Indian River, MI 49749
Phone (231) 238-2302

2230 E Mitchell Rd
Ste B
Petoskey, MI 49770
Phone (231) 348-1011

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710995246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 E MITCHELL RD",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497706601",
            "telephone_number": "231-348-1011",
            "fax_number": "231-348-6998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 E MITCHELL RD",
            "address_2": "SUITE B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497706601",
            "telephone_number": "231-348-1011",
            "fax_number": "231-348-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOSPORT PHYSICAL THERAPY AND ATHLETIC REHABILITATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUDNICK",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "AUGUST",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "231-348-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT,OCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MI",
            "license": "5501008449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.