Active NPI
Ian Christopher Paul, P.T.
- Physical Therapist
- Ruidoso, NM
National Provider Identifier
1093046393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3453
- Practice address
- 147 Mescalero TRL
Ruidoso, NM 88345-6090 - Phone
- (575) 257-5820
- NPI assigned
- Jan 26, 2010
- Last updated
- Jan 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3453 | NM | Primary |
Addresses
Primary practice location
147 Mescalero TRL
Ruidoso, NM 88345-6090
Mailing address
PO Box 7100
Ruidoso, NM 88355-7100
Phone (575) 257-5820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3453 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fowler Enterprises Inc | Physical Therapist | Current | Accepting new patients |
| Therapy Associates Inc | Physical Therapist | Past | Accepting new patients |
Locations
12127 N Highway 14
#B3E
Cedar Crest, NM 87008
Phone (505) 286-3678
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba East Mountain Physical Therapy
- Physical Therapist
- Moriarty, NM
- NPI 1669455994
-
- Physical Therapist
- Ruidoso, NM
- NPI 1902991649
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264464000000",
"number": "1093046393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7100",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "883557100",
"telephone_number": "575-257-5820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 MESCALERO TRL",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "883456090",
"telephone_number": "575-257-5820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAUL",
"first_name": "IAN",
"middle_name": "CHRISTOPHER",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-26",
"last_updated": "2010-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "3453",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruidoso, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2010; 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.