Shelly L Deruiter, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501017393 Issued in MI

Practice address

646 S Waverly Rd
Holland, MI 49423-9121

Phone

(616) 994-8136

Fax

(616) 994-8162

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shelly L Vos Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Work Systems Rehab, PC

  • Physical Therapist
  • Pella, IA
  • NPI 1417047317
  NPD (past)

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1982785259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 S WAVERLY RD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494239121",
            "telephone_number": "616-994-8136",
            "fax_number": "616-994-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 S WAVERLY RD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494239121",
            "telephone_number": "616-994-8136",
            "fax_number": "616-994-8162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUITER",
        "first_name": "SHELLY",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501017393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0449561",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "35426",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "VOS",
            "middle_name": "L",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth Dephouse, BS
• Jack O Derks, MD
• Mary M Derksen, CNS
• Lauren Deroo, LMSW
• Kelsey Deroos
• Eric John Desantis, LLPC
• Ireana Destiney, LLMSW
• Daniel A Dethmers, MD
• Jacquelyn Deur
• Developmental Enhancement

• Physical Therapist in Holland, MI
• Providers in Holland, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; 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.