Individual provider Active NPI

Reuel Joseph Tria, PT

  • Physical Therapist
  • Roswell, NM
National Provider Identifier
1164573119
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305211438 Issued in VA
Practice address
300 N Kentucky Ave
Roswell, NM 88201-4636
Phone
(505) 625-2571
Fax
(505) 627-2544
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3236 NM
Physical Therapist 225100000X 2305211438 VA Primary

Addresses

Primary practice location

300 N Kentucky Ave
Roswell, NM 88201-4636

Mailing address

700 N Missouri Ave Apt 20
Roswell, NM 88201-4860
Phone (505) 317-8559

Other identifiers 1

IdentifierTypeStateIssuer
72021888MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3236NMMDPhysical Therapist
2305211438VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Roswell Independent School District Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1164573119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N MISSOURI AVE APT 20",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014860",
            "telephone_number": "505-317-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N KENTUCKY AVE",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882014636",
            "telephone_number": "505-625-2571",
            "fax_number": "505-627-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIA",
        "first_name": "REUEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "3236",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305211438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "72021888",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; 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.