Diversified PT

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501009094 Issued in MI

Legal business name

DIVERSIFIED PT

Practice address

1635 W Sherman Blvd
Norton Shores, MI 49441-3544

Phone

(231) 755-4404

NPI assigned

Sep 16, 2014

Last updated

Sep 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Deborah Sprague

Title

Pta

Phone

(231) 755-4404

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1790187235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 W SHERMAN BLVD",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494413544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 W SHERMAN BLVD",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494413544",
            "telephone_number": "231-755-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "SPRAGUE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PTA",
        "authorized_official_telephone_number": "231-755-4404"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501009094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicolas Arthur Deboer, DDS
• Megan Melissa Demara, D.P.M.
• Steven S. Demos, M.D.
• Taylor Dew
• Megan Dickerson, OTR
• Diversified PT
• Lauren Donley, DO
• Megan Doornbos
• Virginia E Downey, NURSE PRACTITIONER
• Dr Michael Fischer (Fischer Family Dentistry)

• Physical Therapy Clinic/Center in Norton Shores, MI
• Providers in Norton Shores, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.