Provider Demographics
NPI:1700237450
Name:VIVERANT, LLC
Entity Type:Organization
Organization Name:VIVERANT, LLC
Other - Org Name:VIVERANT
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 1:1769 LEXINGTON AVE N
Mailing Address - Street 2:286
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6522
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:
Practice Address - Street 1:21034 HERON WAY
Practice Address - Street 2:STE 102
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8093
Practice Address - Country:US
Practice Address - Phone:952-835-4512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVERANT PT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-23
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty