Maeselle Tissnolthtos La Paz

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL.0017554 Issued in CO

Practice address

1280 N Mildred Rd
Ste 2
Cortez, CO 81321-2212

Phone

(970) 564-0311

Fax

(970) 564-0313

NPI assigned

Nov 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Johnson Physical Therapy and Rehab PCGroup PAC ID 0446140248, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Johnson Physical Therapy and Rehab PC

  • Physical Therapist
  • Cortez, CO
  • NPI 1982729968
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1033710629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 N MILDRED RD",
            "address_2": "STE 2",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212212",
            "telephone_number": "970-564-0311",
            "fax_number": "970-564-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 N MILDRED RD",
            "address_2": "STE 2",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212212",
            "telephone_number": "970-564-0311",
            "fax_number": "970-564-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA PAZ",
        "first_name": "MAESELLE",
        "middle_name": "TISSNOLTHTOS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "PT5767",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0017554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen D Libsch MD PC
• Kevin Ray Keith, MS CCC SLP
• Casey Kennedy, NCTMB
• Kevin Matteson MD PC
• Cara Kropp
• Amber C Laird, PHARMD
• Casie C Lamunyon, LPC
• Stevi Larue, CPHT
• Jameson Laub, DO
• Tracye A Lederer, M.A.

• Physical Therapist in Cortez, CO
• Providers in Cortez, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.