NPIMap

Organization Active NPI

Ivyrehab Northern PT, LLC

  • Behavior Analyst
  • Howell, MI
National Provider Identifier
1770113680
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
IVYREHAB NORTHERN PT, LLC
Practice address
138 W Highland Rd
Howell, MI 48843-2168
Phone
(517) 376-4831
Fax
(517) 376-4833
NPI assigned
Jan 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Michael Rucker
Title
Ceo
Phone
(914) 777-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

138 W Highland Rd
Howell, MI 48843-2168

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Other practice location 1

8542 W Grand River Ave
Brighton, MI 48116-2326
Phone (734) 449-4649

Other names 1

  • Ivyrehab Northern PT LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ivy Rehab Northern PT2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8542 W Grand River Ave
Brighton, MI 48116
Phone (734) 449-4649

138 W Highland Rd
Howell, MI 48843
Phone (517) 376-4831

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1579478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1770113680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 W HIGHLAND RD",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488432168",
            "telephone_number": "517-376-4831",
            "fax_number": "517-376-4833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8542 W Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481162326",
            "country_code": "US",
            "telephone_number": "734-449-4649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IVYREHAB NORTHERN PT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-20",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "914-777-8700"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivyrehab Northern PT LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ivyrehab Northern PT LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Howell, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.