NPIMap

Organization Active NPI

Northsport Physical Therapy & Rehabilitation P C

  • Physical Therapist
  • Gaylord, MI
National Provider Identifier
1942387733
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NORTHSPORT PHYSICAL THERAPY & REHABILITATION P C
Practice address
1622 Dickerson Rd
Gaylord, MI 49735-9206
Phone
(989) 731-1777
Fax
(989) 731-1166
NPI assigned
Nov 1, 2006
Last updated
Jun 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Authorized official

Name
Ms. Susanne Marie McMillan
Title
Office Manager
Phone
(989) 731-1777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1622 Dickerson Rd
Gaylord, MI 49735-9206

Mailing address

1622 Dickerson Rd
Gaylord, MI 49735-9206
Phone (989) 731-1777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000621 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5294902508 Practice locations: Gaylord, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942387733. Details of each certification follow.

  • CCN 236698 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236698

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
NORTHSPORT PHYSICAL THERAPY & REHAB
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Apr 16, 1996
Last certification
Sep 4, 2019
Ownership / control type
Proprietary
Most recent change of ownership
Oct 26, 1998
Facility address
1622 Dickerson Road
Gaylord, MI 49735

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Northsport Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1622 Dickerson Rd
Gaylord, MI 49735
Phone (989) 731-1777

606 Lake St
Roscommon, MI 48653
Phone (989) 275-5183

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561507200000",
    "number": "1942387733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 DICKERSON RD",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359206",
            "telephone_number": "989-731-1777",
            "fax_number": "989-731-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 DICKERSON RD",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359206",
            "telephone_number": "989-731-1777",
            "fax_number": "989-731-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSPORT PHYSICAL THERAPY & REHABILITATION P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-06-26",
        "status": "A",
        "authorized_official_last_name": "MCMILLAN",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "989-731-1777",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.