Provider Demographics
NPI:1396368866
Name:VIVERANT PT LLC
Entity Type:Organization
Organization Name:VIVERANT PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CERNOHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-835-4512
Mailing Address - Street 1:7825 3RD ST N
Mailing Address - Street 2:STE 105
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5444
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:952-516-5655
Practice Address - Street 1:3912 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST.LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-0515
Practice Address - Country:US
Practice Address - Phone:952-835-4512
Practice Address - Fax:952-515-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty