NPIMap

Organization Active NPI

Rock Physical Therapy Resilience & Training Center PC

  • Physical Therapy Clinic/Center
  • Farmington, NM
National Provider Identifier
1164038204
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ROCK PHYSICAL THERAPY RESILIENCE & TRAINING CENTER PC
Practice address
845 Sullivan Ave
Farmington, NM 87401-7356
Phone
(505) 860-7812
NPI assigned
Sep 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Authorized official

Name
Dr. Marlyn Brian Wyatt, DPTNPI 1194355719
Title
Owner/Physical Therapist
Phone
(505) 278-8295

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 1

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

Addresses

Primary practice location

845 Sullivan Ave
Farmington, NM 87401-7356

Mailing address

845 N Sullivan Ave
Farmington, NM 87401-7356
Phone (505) 278-8295

Other names 1

  • Rock Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210602000090 NM Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1355751876 Receives reassigned benefits from 1 practitioner
Practice locations: Farmington, NM

National Provider Directory

National Provider Directory

Locations

845 Sullivan Ave
Farmington, NM 87401
Phone (505) 278-8295

Practitioners & affiliated clinicians

Practitioners 2

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": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1164038204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N SULLIVAN AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874017356",
            "telephone_number": "505-278-8295",
            "fax_number": "505-436-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 SULLIVAN AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874017356",
            "telephone_number": "505-860-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCK PHYSICAL THERAPY RESILIENCE & TRAINING CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "MARLYN",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "505-278-8295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.