OrganizationActive
Viverant, LLC
NPI 1124540968 · Physical Therapist · Saint Louis Park, MN
Provider details
- NPI number
- 1124540968
- Entity type
- Organization
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Parent organization
- Viverant PT LLC
- Organization subpart
- Yes
- Authorized official
- Michael Lanham, Director(952) 835-4512
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Registered Dietitian133V00000X
Dietary & Nutritional Service Providers
Profile Score
Established profile(69/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3912 Excelsior Blvd
Saint Louis Park, MN 55416-4709
Phone: (952) 835-4512
Street-level locationGet directions
Mailing address
7825 3rd St N
Oakdale, MN 55128-5444
Registry dates
- Enumerated
- 2017-07-13
- Last updated
- 2020-06-01
- Certified
- 2020-06-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.