Active NPI
Paula L Fortune, MSPT
- Physical Therapist
- Niles, MI
National Provider Identifier
1962903294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501010993
- Practice address
- 423 Sycamore St Ste 104
Niles, MI 49120-2374 - Phone
- (269) 687-2900
- Fax
- (269) 687-2903
- NPI assigned
- Feb 22, 2018
- Last updated
- Mar 17, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05007396A | IN | |
| Physical Therapist | 225100000X | 5501010993 | MI | Primary |
Addresses
Primary practice location
423 Sycamore St Ste 104
Niles, MI 49120-2374
Mailing address
9466 Fox Run
Berrien Center, MI 49102-8710
Phone (269) 473-5655
Other practice location 1
51099 Bittersweet Rd Ste E
Granger, IN 46530-4990
Phone (574) 318-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05007396A | IN | MD | Physical Therapist |
| 5501010993 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michiana Home Care, LLC | Past | Accepting new patients | |
| Michiana Home Care, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1962903294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9466 FOX RUN",
"city": "BERRIEN CENTER",
"state": "MI",
"postal_code": "491028710",
"telephone_number": "269-473-5655",
"fax_number": "269-473-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "423 SYCAMORE ST STE 104",
"city": "NILES",
"state": "MI",
"postal_code": "491202374",
"telephone_number": "269-687-2900",
"fax_number": "269-687-2903"
}
],
"practiceLocations": [
{
"address_1": "51099 Bittersweet Rd Ste E",
"address_purpose": "LOCATION",
"city": "Granger",
"state": "IN",
"postal_code": "465304990",
"country_code": "US",
"telephone_number": "574-318-3900",
"fax_number": "574-318-3903",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FORTUNE",
"first_name": "PAULA",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-22",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05007396A",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501010993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.