NPIMap

Organization Active NPI

Functional Dimensions LLC

  • Orthopedic Physical Therapist
  • Traverse City, MI
National Provider Identifier
1780076232
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
FUNCTIONAL DIMENSIONS LLC
Practice address
3899 W. Front St Unit 3
Traverse City, MI 49684
Phone
(231) 649-2015
Fax
(231) 421-8447
NPI assigned
Feb 20, 2015
Last updated
Dec 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Andrew Charles GoreckiNPI 1902137920
Title
Owner
Phone
(231) 649-2015

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5501014611 MI
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X Primary

Addresses

Primary practice location

3899 W. Front St Unit 3
Traverse City, MI 49684

Mailing address

3899 W. Front St Unit 3
Traverse City, MI 49684
Phone (231) 649-2015

Other names 1

  • Superior Physical Therapy Other name

National Provider Directory

National Provider Directory

Locations

3899 W Front St
Ste 3
Traverse City, MI 49684
Phone (231) 421-9277

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1424390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1780076232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3899 W. FRONT ST UNIT 3",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-649-2015",
            "fax_number": "231-421-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3899 W. FRONT ST UNIT 3",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-649-2015",
            "fax_number": "231-421-8447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL DIMENSIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-20",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "GORECKI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-649-2015"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501014611",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Physical Therapy",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Superior Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; 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.