NPIMap

Organization Active NPI

Mile High Physical Therapy Professional Corporation

  • Physical Therapist
  • Pine Brook, NJ
National Provider Identifier
1730665662
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MILE HIGH PHYSICAL THERAPY PROFESSIONAL CORPORATION
Practice address
321 Changebridge Rd
Pine Brook, NJ 07058-9583
Phone
(973) 396-8585
Fax
(973) 396-8587
NPI assigned
Jul 13, 2018
Last updated
Oct 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Dr. Eric William Stivers, PT, DPT,OCSNPI 1982837423
Title
Owner
Phone
(973) 769-1001

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
Physical Therapist 225100000X Primary

Addresses

Primary practice location

321 Changebridge Rd
Pine Brook, NJ 07058-9583

Mailing address

321 Changebridge Rd
Pine Brook, NJ 07058-9583
Phone (973) 396-8585

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190327001346 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7911257597 Receives reassigned benefits from 9 practitioners
Practice locations: Pine Brook, NJ; Towaco, NJ

National Provider Directory

National Provider Directory

Locations

321 Changebridge Rd
Ste 103
Pine Brook, NJ 07058
Phone (973) 396-8585

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1730665662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 CHANGEBRIDGE RD",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589583",
            "telephone_number": "973-396-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 CHANGEBRIDGE RD",
            "city": "PINE BROOK",
            "state": "NJ",
            "postal_code": "070589583",
            "telephone_number": "973-396-8585",
            "fax_number": "973-396-8587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE HIGH PHYSICAL THERAPY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-13",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "STIVERS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-769-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT,OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Brook, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.