Upper Peninsuls Sports Medicine & Therapy Center

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

5501001972 Issued in MI

Legal business name

UPPER PENINSULS SPORTS MEDICINE & THERAPY CENTER

Practice address

1414 W Fair Ave
Suite 101
Marquette, MI 49855-2675

Phone

(906) 228-2595

Fax

(906) 228-3313

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Debra Lee Nevenhoven

Title

Office Manager

Phone

(906) 228-2595

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952420358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "SUITE 101",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-228-2595",
            "fax_number": "906-228-3313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE",
            "address_2": "SUITE 101",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552675",
            "telephone_number": "906-228-2595",
            "fax_number": "906-228-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER PENINSULS SPORTS MEDICINE & THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NEVENHOVEN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "906-228-2595",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501001972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "30455",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Upper Peninsula Association of Rural Health Services, Inc.
• Upper Peninsula Health Care Solutions, Inc.
• Upper Peninsula Managed Care, LLC
• Upper Peninsula Rehabilitation Medicine Associates P.C.
• Upper Peninsula Sports Medicine & Therapy Center
• Nancy Uschold, P.T.
• Tabitha Utych
• Ivy Marie Vachon
• Diane Valenzio, B.S.N., M.S.N.
• Toni Valesano, RN

• Physical Therapy Clinic/Center in Marquette, MI
• Providers in Marquette, 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 Aug 22, 2020; 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.