NPIMap

Organization Active NPI

Foothills Sports Medicine & Rehabilitation Litchfield Park, LLC

  • Physical Therapist
  • Litchfield Park, AZ
National Provider Identifier
1134317779
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
FOOTHILLS SPORTS MEDICINE & REHABILITATION LITCHFIELD PARK, LLC
Practice address
5110 N Dysart Rd
Suite 148
Litchfield Park, AZ 85340-3058
Phone
(623) 547-4739
Fax
(623) 536-2154
NPI assigned
Oct 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Mr. Eric Blasin, P.T.
Title
Owner
Phone
(623) 547-4739

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X

Addresses

Primary practice location

5110 N Dysart Rd
Suite 148
Litchfield Park, AZ 85340-3058

Mailing address

5110 N Dysart Rd
Suite 148
Litchfield Park, AZ 85340-3058
Phone (623) 547-4739

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071126000534 AZ Part B Supplier - Clinic/Group Practice 9537257654 Receives reassigned benefits from 10 practitioners
Practice locations: Litchfield Park, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1134317779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5110 N DYSART RD",
            "address_2": "SUITE 148",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853403058",
            "telephone_number": "623-547-4739",
            "fax_number": "623-536-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5110 N DYSART RD",
            "address_2": "SUITE 148",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853403058",
            "telephone_number": "623-547-4739",
            "fax_number": "623-536-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS SPORTS MEDICINE & REHABILITATION LITCHFIELD PARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "BLASIN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "623-547-4739",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Litchfield Park, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.