NPIMap

Organization Active NPI

South Mountain Rehabilitation P.C.

  • Chiropractor
  • Phoenix, AZ
National Provider Identifier
1124176342
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5302 Issued in AZ
Legal business name
SOUTH MOUNTAIN REHABILITATION P.C.
Practice address
4804 E Chandler Blvd
106
Phoenix, AZ 85048-0857
Phone
(480) 893-6020
Fax
(480) 785-5161
NPI assigned
Jan 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Authorized official

Name
Dr. Peter Vincent Pakulis, D.C.,P.T.
Title
President
Phone
(480) 759-1082

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 5302 AZ Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 2853 AZ

Addresses

Primary practice location

4804 E Chandler Blvd
106
Phoenix, AZ 85048-0857

Mailing address

16016 S 45TH PL
Phoenix, AZ 85048-7635
Phone (480) 759-1082

Other identifiers 2

IdentifierTypeStateIssuer
AZ0241550OtherAZBCBS CHIROPRACTIC #
AZ0295410OtherAZBCBS PHYSICAL THERAPY #

National Provider Directory

National Provider Directory

Locations

4804 E Chandler Blvd
Ste 106
Phoenix, AZ 85048
Phone (480) 893-6020

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1124176342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16016 S 45TH PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850487635",
            "telephone_number": "480-759-1082",
            "fax_number": "480-785-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4804 E CHANDLER BLVD",
            "address_2": "106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850480857",
            "telephone_number": "480-893-6020",
            "fax_number": "480-785-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN REHABILITATION P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "PAKULIS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-759-1082",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C.,P.T."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "5302",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "2853",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CHIROPRACTIC #",
            "identifier": "AZ0241550",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PHYSICAL THERAPY #",
            "identifier": "AZ0295410",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.