GREAT LAKES PHYSICAL THERAPY (NPI# 1063785384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063785384 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PHYSICAL THERAPY |
| Practice Address |
214 N Division St Traverse City MI 49684-2231 |
| Practice Telephone | 2319418100 |
| Practice Fax Number | 2319418812 |
| Mailing Telephone | 2319418100 |
| Mailing Fax Number | 2319418812 |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2012-02-16 |
| Authorized Official Name | MS. PATTI CAIRNS (BILLING MANAGER) |
| Authorized Official Telephone | 2319418100 |
| Is Organization Subpart | Y |
| Parent Organization Name | GREAT LAKES THERAPY HOUSE CALLS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSM GROUP NUMBER | 0B81385 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033407507 | Great Lakes Physical Therapy | Speech-Language Pathologist | 3301 Bergquist Ave, Spirit Lake, IA 51360-7679 | 2011-07-18 |
| 1346473527 | Great Lakes Physical Therapy | Clinic/Center | 23300 Greenfield Rd, Suite 105, Oak Park, MI 48237-5237 | 2009-09-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | GREAT LAKES PHYSICAL THERAPY, P. C. | 3301 Bergquist Avenue, Spirit Lake, IA 51360 |
| Street Address |
214 N DIVISION ST |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-2231 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740894500 | Sara Sue Laisure | Clinic/Center | 1105 E 8th St, Traverse City, MI 49686-2936 | 2020-08-31 |
| 1578961827 | Orthopedic 360 Physical Therapy, LLC | Clinic/Center | 830 Cottageview Dr Ste 204, Traverse City, MI 49684-2384 | 2014-12-17 |
| 1972864585 | Maverick Consulting LLC | Clinic/Center | 633 W South Airport Rd # B, Traverse City, MI 49686 | 2012-05-31 |
| 1427343383 | Elite Physical Therapy and Sports Performance | Clinic/Center | 4177 Village Park Dr, Suite B, Traverse City, MI 49685-7237 | 2011-06-17 |
| 1346410826 | Grand Traverse Physical Therapy, P.C. | Clinic/Center | 735 S Garfield Ave, Suite 100, Traverse City, MI 49686-3489 | 2008-03-11 |
| 1528104114 | Fitness Center Physical Therapy | Clinic/Center | 425 Boardman Ave, Traverse City, MI 49684-2562 | 2007-01-30 |
| 1851870281 | Hannah Rose Mulder | Clinic/Center | 830 Cottageview Dr Ste 204, Traverse City, MI 49684-2384 | 2018-08-07 |
| 1093069734 | Great Lakes Therapy Housecalls, P.C. | Clinic/Center | 9731 E Cherry Bend Rd, Ste A, Traverse City, MI 49684-7621 | 2012-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629679485 | Thrive Physical Therapy | Clinic/Center | 835 Mason St Ste A245, Dearborn, MI 48124-2231 | 2020-11-06 |
| 1700484482 | Redford Physical Therapy LLC | Clinic/Center | 25136 W 6 Mile Rd, Redford, MI 48240-2102 | 2020-10-14 |
| 1578176269 | Pro-line Physical Therapy, LLC | Clinic/Center | 25899 W 12 Mile Rd Ste 335, Southfield, MI 48034-8343 | 2020-08-24 |
| 1326650011 | Physical Therapy Center for Sports and Performing Arts, Pllc | Clinic/Center | 30475 Stephenson Hwy, Madison Heights, MI 48071-1615 | 2020-08-23 |
| 1770194607 | Restorative Rehabilitation Inc | Clinic/Center | 9228 Pelham Rd, Taylor, MI 48180-3832 | 2020-08-13 |
| 1528679081 | Activo Physical Therapy, LLC | Clinic/Center | 5140 Coolidge Hwy, Ste 101, Royal Oak, MI 48073 | 2020-08-10 |
| 1114537719 | Axpert Rehab Care, LLC | Clinic/Center | 22830 Kelly Rd, Eastpointe, MI 48021-2072 | 2020-08-07 |
| 1619586898 | Right Health, PC | Clinic/Center | 28345 Beck Rd Ste 412, Wixom, MI 48393-4745 | 2020-07-23 |
| 1497378368 | Launch Pediatric Rehab | Clinic/Center | 13448 Greenbriar Dr, Grand Haven, MI 49417-9161 | 2020-05-26 |
| 1003437195 | Delight Health Services LLC | Clinic/Center | 4123 Martin Rd Ste 201, Commerce Township, MI 48390-4151 | 2020-04-30 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.