Vantage Rehab Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

01774 Issued in IA

Legal business name

VANTAGE REHAB INC

Practice address

500 N Broad St
Shenandoah, IA 51601-1318

Phone

(712) 246-2268

Fax

(712) 246-2110

NPI assigned

Sep 14, 2012

Last updated

Nov 2, 2012By 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

Lesli Nordhues, OTNPI 1568643237

Title

Owner/OT

Phone

(712) 303-9948

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922358175. Details of each certification follow.

• CCN 166608 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 166608

Legal name

VANTAGE REHAB, INC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jun 11, 2013

Last certification

Mar 18, 2016

Ownership / control type

Proprietary

Facility address

500 N Broad Street
Shenandoah, IA 51601

Locations

Practitioners 1

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.

• Lesli Deanne Nordhues, OTR/L

  • Occupational Therapist
  • Shenandoah, IA
  • NPI 1568643237
  NPD (past) Authorized official

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1922358175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N BROAD ST",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516011318",
            "telephone_number": "712-246-2268",
            "fax_number": "712-246-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N BROAD ST",
            "city": "SHENANDOAH",
            "state": "IA",
            "postal_code": "516011318",
            "telephone_number": "712-246-2268",
            "fax_number": "712-246-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANTAGE REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "NORDHUES",
        "authorized_official_first_name": "LESLI",
        "authorized_official_title_or_position": "OWNER/OT",
        "authorized_official_telephone_number": "712-303-9948",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IA",
            "license": "01774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811265366",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1568643237",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin David Thomas, PHARMD
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• Rose Walter, ARNP
• Karen Webster
• Robert Weidman, RPH

• Physical Therapy Clinic/Center in Shenandoah, IA
• Providers in Shenandoah, IA by specialty
• Physical Therapy Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.