Provider Demographics
NPI: | 1760418164 |
---|---|
Name: | VIVERANT, LLC |
Entity Type: | Organization |
Organization Name: | VIVERANT, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | BUSINESS 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: | 651-283-6364 |
Mailing Address - Street 1: | 7815 3RD ST N |
Mailing Address - Street 2: | STE 203 |
Mailing Address - City: | OAKDALE |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55128-5447 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-835-4512 |
Mailing Address - Fax: | 518-677-1149 |
Practice Address - Street 1: | 7815 3RD ST N |
Practice Address - Street 2: | STE 203 |
Practice Address - City: | OAKDALE |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55128-5447 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-835-4512 |
Practice Address - Fax: | 518-677-1149 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | VIVERANT PT LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-06-25 |
Last Update Date: | 2020-06-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |