NPIMap

Organization Active NPI

The Physio Shop LLC

  • Physical Therapy Clinic/Center
  • Flagstaff, AZ
National Provider Identifier
1134524234
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
THE PHYSIO SHOP LLC
Practice address
1510 S. Riordan Ranch St.
Flagstaff, AZ 86001
Phone
(928) 214-7303
Fax
(928) 214-0696
NPI assigned
Oct 31, 2014
Last updated
May 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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

Authorized official

Name
Jason Christopher Dorsch, AT, DPTNPI 1023328804
Title
DPT/Owner
Phone
(928) 214-7303

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 9032 AZ
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1510 S. Riordan Ranch St.
Flagstaff, AZ 86001

Mailing address

1510 S. Riordan Ranch St.
Flagstaff, AZ 86001
Phone (928) 214-7303

Other practice location 1

6011 N. Oracle Rd
Suite # 151
Tucson, AZ 85704-5309
Phone (928) 214-7303

Other identifiers 1

IdentifierTypeStateIssuer
126915MedicaidAZ

Other names 1

  • Body Shop Physical Therapy and Wellness Center, LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150326000845 AZ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8123345451 Receives reassigned benefits from 17 practitioners
Practice locations: Flagstaff, AZ; Tucson, AZ

National Provider Directory

National Provider Directory

Locations

1510 S Riordan Ranch St
Flagstaff, AZ 86001
Phone (928) 214-7303

515 N Beaver St
Flagstaff, AZ 86001
Phone (928) 213-8263

6011 N Oracle Rd
#151
Tucson, AZ 85704
Phone (520) 561-0101

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1134524234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S. RIORDAN RANCH ST.",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-214-7303",
            "fax_number": "928-214-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S. RIORDAN RANCH ST.",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-214-7303",
            "fax_number": "928-214-0696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6011 N. Oracle Rd",
            "address_2": "Suite # 151",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857045309",
            "country_code": "US",
            "telephone_number": "928-214-7303",
            "fax_number": "928-214-0696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE PHYSIO SHOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-31",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "DORSCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DPT/OWNER",
        "authorized_official_telephone_number": "928-214-7303",
        "authorized_official_credential": "AT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "9032",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126915",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Body Shop Physical Therapy and Wellness Center, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 May 25, 2021; 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.