Active Recovery Physical Therapy & Sports Rehab

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ACTIVE RECOVERY PHYSICAL THERAPY & SPORTS REHAB

Practice address

250 S Lake St Ste E
East Jordan, MI 49727-9376

Phone

(231) 222-2121

NPI assigned

Jul 27, 2020

Last updated

Oct 15, 2020By 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

Kristina NowkaNPI 1235404948

Title

Owner, at, Pta

Phone

(989) 996-1098

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 3

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.

• Casey Keane, PT, DPT, AT, ATC

  • Physical Therapist
  • East Jordan, MI
  • NPI 1275054876
  Medicare reassignment Care Compare group NPD
• Jaleesa O'Neal, PT, DPT

  • Physical Therapist
  • East Jordan, MI
  • NPI 1881195824
  Medicare reassignment Care Compare group NPD
• Kristina K Nowka, AT, PTA

  • Physical Therapy Assistant
  • East Jordan, MI
  • NPI 1235404948
  NPD Authorized official

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1891304812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S LAKE ST STE E",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279376",
            "telephone_number": "231-222-2121",
            "fax_number": "231-222-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S LAKE ST STE E",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279376",
            "telephone_number": "231-222-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE RECOVERY PHYSICAL THERAPY & SPORTS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-27",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "NOWKA",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER, AT, PTA",
        "authorized_official_telephone_number": "989-996-1098"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Web-based",
            "affiliation": "N",
            "endpointDescription": "webPT",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "240 S Lake St Spc 6",
            "city": "East Jordan",
            "state": "MI",
            "country_code": "US",
            "postal_code": "497279376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Access Dental-East Jordan, PC
• Robert Fraser Allum, DO
• William B Bice, RPH
• Leah Blacktop
• Natalie Bowen
• Courtney Brinkman, NP-C

• Physical Therapist in East Jordan, MI
• Providers in East Jordan, MI by specialty
• Physical Therapist in Michigan

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