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?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty