Individual provider Active NPI

Nicholas Ryan Bibeau, DPT

  • Physical Therapist
  • Apache Junction, AZ
National Provider Identifier
1174022990
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
LPT-30635 Issued in AZ
Practice address
1075 S Idaho Rd Ste 210
Apache Junction, AZ 85119-6405
Phone
(480) 983-0877
Fax
(480) 983-3172
NPI assigned
Feb 7, 2018
Last updated
Dec 9, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X LPT-30635 AZ Primary

Addresses

Primary practice location

1075 S Idaho Rd Ste 210
Apache Junction, AZ 85119-6405

Mailing address

625 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2395
Phone (616) 356-5000

Other practice location 1

40601 N Gantzel Rd Ste 103
San Tan Valley, AZ 85140-7036
Phone (602) 648-5444

Other practice location 2

6620 E McKellips Rd Ste 105
Mesa, AZ 85215-2867
Phone (602) 648-5444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191018002493 AZ Practitioner - Physical Therapist in Private Practice 5294083689 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Continuum Wellness Clinic LLCGroup PAC ID 7012802713, 6 clinicians

Practice addresses (Care Compare)

1075 S Idaho Rd
Suite 210
Apache Junction, AZ 85119-6405
Phone (480) 983-0877

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11350TNMDGeneral Practice Dentistry
LPT-30635AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Specialists of North America, PLLC Physical Therapist CurrentSince Oct 27, 2025 Accepting new patients
Orthopedic Specialists of North America, PLLC Current Accepting new patients
Orthopedic Specialists of North America, PLLC CurrentSince Oct 27, 2025 Accepting new patients
Continuum Wellness Clinic LLC Physical Therapist CurrentSince Dec 8, 2025 Accepting new patients
Continuum Wellness Clinic, LLC CurrentSince Dec 8, 2025 Accepting new patients

Locations

1075 S Idaho Rd
Ste 210
Apache Junction, AZ 85119
Phone (480) 983-0877

6620 E McKellips Rd
Ste 105
Mesa, AZ 85215
Phone (602) 922-9090

40601 N Gantzel Rd
Ste 103
San Tan Vly, AZ 85140

5620 E Bell Rd
Scottsdale, AZ 85254
Phone (602) 485-3050

625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1174022990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 KENMOOR AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462395",
            "telephone_number": "616-356-5000",
            "fax_number": "616-356-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 S IDAHO RD STE 210",
            "city": "APACHE JUNCTION",
            "state": "AZ",
            "postal_code": "851196405",
            "telephone_number": "480-983-0877",
            "fax_number": "480-983-3172"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40601 N Gantzel Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "San Tan Valley",
            "state": "AZ",
            "postal_code": "851407036",
            "country_code": "US",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6620 E McKellips Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852152867",
            "country_code": "US",
            "telephone_number": "602-648-5444",
            "fax_number": "602-772-3801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIBEAU",
        "first_name": "NICHOLAS",
        "middle_name": "RYAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-07",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-30635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apache Junction, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.