Sport Summit Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SPORT SUMMIT PHYSICAL THERAPY LLC

Practice address

1513 N McEwan St
Clare, MI 48617-1162

Phone

(989) 621-0457

NPI assigned

Aug 6, 2019

Organization subpart

No

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

Authorized official

Name

Jordan McConnell, DPTNPI 1023508660

Title

Owner/Therapist

Phone

(989) 424-6088

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

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

• Jordan McConnell, DPT

  • Physical Therapist
  • Clare, MI
  • NPI 1023508660
  Medicare reassignment Care Compare group NPD Authorized official
• Jesse Kroll

  • Physical Therapist
  • Clare, MI
  • NPI 1891313672
  Medicare reassignment Care Compare group NPD
• Kyle A Mason, PT

  • Physical Therapist
  • Mt Pleasant, MI
  • NPI 1225398100
  Medicare reassignment Care Compare group NPD
• Jacob McFadden, DPT

  • Physical Therapist
  • Clare, MI
  • NPI 1588347108
  Medicare reassignment Care Compare group NPD
• David Wenzel

  • Physical Therapist
  • Houghton Lake, MI
  • NPI 1649653429
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1861047847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11799 S EBERHART AVE",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486179686",
            "telephone_number": "989-424-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 N MCEWAN ST",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171162",
            "telephone_number": "989-621-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT SUMMIT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-06",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "989-424-6088",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leilani Smith
• Weslie Michelle Smith
• Joann Lynn Smylie
• Marysusan V. Snively, PT, DPT
• Kylie Jade Spann
• Jamie Stratton, LPTA
• Margaret Taylor, PT, DPT
• Ten Sixteen Recovery Network
• Tendercare (Michigan) Inc.
• Kelly Jo Thume

• Physical Therapy Clinic/Center in Clare, MI
• Providers in Clare, 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 Dec 27, 2019; 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.