NPIMap

Organization Active NPI

Basecamp Physical Therapy and Performance of Flagstaff LLC

  • Physical Therapy Clinic/Center
  • Flagstaff, AZ
National Provider Identifier
1033994736
Registry record updated Sep 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BASECAMP PHYSICAL THERAPY AND PERFORMANCE OF FLAGSTAFF LLC
Practice address
2619 S Woodlands Village Blvd Ste 750
Flagstaff, AZ 86001-1628
Phone
(928) 224-0747
Fax
(928) 224-0802
NPI assigned
Aug 30, 2023
Last updated
Sep 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2023

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

Authorized official

Name
Logan Madding
Title
Director of Business Operations
Phone
(928) 224-0747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2619 S Woodlands Village Blvd Ste 750
Flagstaff, AZ 86001-1628

Mailing address

2619 S Woodlands Village Blvd Ste 750
Flagstaff, AZ 86001-1628
Phone (928) 224-0747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231116001931 AZ Part B Supplier - Clinic/Group Practice 1759738453 Receives reassigned benefits from 8 practitioners
Practice locations: Flagstaff, AZ

National Provider Directory

National Provider Directory

Locations

2619 S Woodlands Village Blvd
Ste 750
Flagstaff, AZ 86001
Phone (928) 224-0747

3470 E Route 66
Ste 101
Flagstaff, AZ 86004
Phone (928) 224-0747

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1693353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693526400000",
    "number": "1033994736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 S WOODLANDS VILLAGE BLVD STE 750",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011628",
            "telephone_number": "928-224-0747",
            "fax_number": "928-224-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 S WOODLANDS VILLAGE BLVD STE 750",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011628",
            "telephone_number": "928-224-0747",
            "fax_number": "928-224-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASECAMP PHYSICAL THERAPY AND PERFORMANCE OF FLAGSTAFF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A",
        "authorized_official_last_name": "MADDING",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "928-224-0747"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.