Provider Demographics
NPI:1346773330
Name:VIVERANTOS, LLC
Entity Type:Organization
Organization Name:VIVERANTOS, LLC
Other - Org Name:VIVERANTOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-835-4512
Mailing Address - Street 1:1029 W CENTRAL ENTRANCE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5477
Mailing Address - Country:US
Mailing Address - Phone:218-624-2794
Mailing Address - Fax:
Practice Address - Street 1:1769 LEXINGTON AVE N
Practice Address - Street 2:286
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6522
Practice Address - Country:US
Practice Address - Phone:218-624-2794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty