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NPI Code Detail

MEDICARE: VIVERANT, LLC

MEDICARE: VIVERANT, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1629595947
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIVERANT, LLC
Provider Business Mailing Address
First Line : 1769 LEXINGTON AVE N # 286
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-6522
Country : US
Telephone Number : 952-835-4512
Fax Number :
Provider Business Practice Location Address
First Line : 5400 FRANCE AVE S
Second Line :
City : EDINA
State : MN
Zip : 55410-2356
Country : US
Telephone Number : 952-835-4512
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MICHAEL LANHAM
Credential :
Telephone Number : 952-835-4512
Provider Enumeration Date : 08/28/2017
Last Update Date : 06/01/2020

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Directions to “VIVERANT, LLC ” Practice Location

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