NPIMap

Organization Active NPI

Ivyrehab Northern PT, LLC

  • Physical Therapy Clinic/Center
  • Sparta, MI
National Provider Identifier
1972592525
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
IVYREHAB NORTHERN PT, LLC
Practice address
31 Ida Red Ave
Sparta, MI 49345-1277
Phone
(616) 887-8152
Fax
(616) 887-3809
NPI assigned
Oct 17, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Mr. Michael Rucker
Title
Ceo
Phone
(914) 777-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

31 Ida Red Ave
Sparta, MI 49345-1277

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Other names 1

  • Northern Physical Therapy Services Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030305000005 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3072422492 Practice locations: Norton Shores, MI; Wayland, MI; Sparta, MI; Muskegon, MI; Lowell, MI; Howell, MI; Grant, MI; Grand Rapids, MI…

National Provider Directory

National Provider Directory
Tax ID family
Ivy Rehab Northern PT2 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

1424 S Main St
Adrian, MI 49221
Phone (517) 312-1711

1424 S Main St
Ste 1
Adrian, MI 49221
Phone (517) 312-1712

6193 Lake Michigan Dr
Ste 6173
Allendale, MI 49401

6193 Lake Michigan Dr
Ste 6171
Allendale, MI 49401

9321 Cherry Valley Ave SE
Caledonia, MI 49316
Phone (616) 536-9339

308 S Main St
Cedar Springs, MI 49319
Phone (616) 361-5001

4615 West River Dr NE
Ste B
Comstock Park, MI 49321
Phone (616) 947-2720

4095 Park East Ct SE
Grand Rapids, MI 49546
Phone (616) 259-4028

17615 W Moore
Grant, MI 49327
Phone (231) 834-0208

2050 W Main St
Ste H
Lowell, MI 49331

2050 W Main St
Ste 500
Lowell, MI 49331
Phone (616) 987-0019

31 Ida Red Ave
Sparta, MI 49345
Phone (616) 887-8152

709 W Superior St
Wayland, MI 49348
Phone (269) 792-4440

Practitioners & affiliated clinicians

Practitioners 159

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 159

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1972592525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 IDA RED AVE",
            "city": "SPARTA",
            "state": "MI",
            "postal_code": "493451277",
            "telephone_number": "616-887-8152",
            "fax_number": "616-887-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVYREHAB NORTHERN PT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "914-777-8700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Physical Therapy Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sparta, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.