NPIMap

Organization Active NPI

Vibrantcare Outpatient Rehabilitation West Inc

Doing business as VibrantCare Rehabilitation

  • Physical Therapy Clinic/Center
  • Phoenix, AZ
National Provider Identifier
1114921871
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
VIBRANTCARE OUTPATIENT REHABILITATION WEST INC
Doing business as
VibrantCare Rehabilitation
Practice address
1728 W Glendale Ave Ste 102
Phoenix, AZ 85021-8862
Phone
(602) 249-0202
Fax
(602) 249-0004
NPI assigned
Jun 10, 2005
Last updated
Nov 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Authorized official

Name
Mr. David Smith
Title
Ceo
Phone
(916) 782-1212

Specialties & licenses 1

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

Addresses

Primary practice location

1728 W Glendale Ave Ste 102
Phoenix, AZ 85021-8862

Mailing address

PO Box 840301
Los Angeles, CA 90084-0301
Phone (916) 789-8115

Other names 1

  • VibrantCare Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050318000239 AZ Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 9133174568 Practice locations: Mesa, AZ; Tempe, AZ; Phoenix, AZ; Peoria, AZ; Goodyear, AZ; Glendale, AZ; Chandler, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114921871. Details of each certification follow.

  • CCN 036541 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 036541

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
VIBRANTCARE OUTPATIENT REHABILITATION WEST
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Feb 25, 1992
Last certification
Feb 3, 2023
Ownership / control type
Proprietary
Most recent change of ownership
May 1, 2005
Facility address
1728 W Glendale Ave St 102
Phoenix, AZ 85021

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Novacare Outpatient Rehabilitation West Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1850 E Northrop Blvd
Ste 120
Chandler, AZ 85286
Phone (480) 892-7986

5440 E Southern Ave
Ste 101
Mesa, AZ 85206
Phone (480) 641-3533

2020 N Central Ave
Ste P100
Phoenix, AZ 85004
Phone (602) 256-7232

4515 S McClintock Dr
Ste 110
Tempe, AZ 85282
Phone (480) 839-2196

Practitioners & affiliated clinicians

Practitioners 68

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.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700438400000",
    "number": "1114921871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840301",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900840301",
            "telephone_number": "916-789-8115",
            "fax_number": "916-773-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1728 W GLENDALE AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850218862",
            "telephone_number": "602-249-0202",
            "fax_number": "602-249-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANTCARE OUTPATIENT REHABILITATION WEST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-782-1212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VibrantCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "VibrantCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.