Evergreen Physical Therapy Limited Partnership
Organization Active NPI Physical Therapy Clinic/Center · Harrison, MI
NPI 1962515809 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1962515809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- EVERGREEN PHYSICAL THERAPY LIMITED PARTNERSHIP
- Practice address
- 158 North First Street
Suite D
Harrison, MI 48625 - Phone
- (989) 539-4167
- Fax
- (989) 539-4436
- NPI assigned
- Aug 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Janna P. King, JD
- Title
- VP, Authorized Official
- Phone
- (713) 297-7000
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 3
Practitioners 1
-
Matthew Dwayne Blick, PHYSICAL THERAPIST
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070516000180 | MI | Part B Supplier - Clinic/Group Practice | 7618074220 |
Receives reassigned benefits from 12 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Big Rapids, MI; Clare, MI; Gladwin, MI; Harrison, MI; Midland, MI |
National Provider Directory
- Tax ID family
- Evergreen PT Partnership
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Yes |
Addresses
Primary practice location
158 North First Street
Suite D
Harrison, MI 48625
Mailing address
1300 W Sam Houston Pkwy S
Suite 300
Houston, TX 77042-2447
Phone (713) 297-7000
Other providers in Harrison, MI
- Shylo Delashmit
- Janeen Noella Dubey
- Jennifer Dunlop
- Matthew Bernard Dussia
- Danielle Renee Eppert
- Family Fare, LLC
- Amanda Fetterolf
- Brenda Kay Fowler
- Mary Fowler
- Brittany Freebury
All providers in Harrison, MI · Physical Therapy Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.