Alans Physical Therapy of Grand Rapids

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

7152 Issued in MN

Legal business name

ALANS PHYSICAL THERAPY OF GRAND RAPIDS

Practice address

111 Golf Course Rd
Suite 2
Grand Rapids, MN 55744-3526

Phone

(218) 999-5554

Fax

(218) 999-7620

NPI assigned

Mar 17, 2014

Organization subpart

No

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

Authorized official

Name

Alan Jay Dettmer, PT

Title

Owner

Phone

(218) 999-5554

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1811313612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 GOLF COURSE RD",
            "address_2": "SUITE 2",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443526",
            "telephone_number": "218-999-5554",
            "fax_number": "218-999-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GOLF COURSE RD",
            "address_2": "SUITE 2",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443526",
            "telephone_number": "218-999-5554",
            "fax_number": "218-999-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALANS PHYSICAL THERAPY OF GRAND RAPIDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "DETTMER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-999-5554",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": "7152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962479436",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.