NPIMap

Organization Active NPI

Physical Therapy Center, LLC

  • Physical Therapy Clinic/Center
  • Las Vegas, NM
National Provider Identifier
1174867915
Registry record updated Jun 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
4234 Issued in NM
Legal business name
PHYSICAL THERAPY CENTER, LLC
Practice address
1607 7TH St Ste C
Las Vegas, NM 87701-4952
Phone
(505) 454-1213
NPI assigned
Nov 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2014

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

Authorized official

Name
Logan Arden Kanode, DPT
Title
Owner
Phone
(505) 454-1213

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 4234 NM
Physical Therapy Clinic/Center 261QP2000X 4234 NM Primary

Addresses

Primary practice location

1607 7TH St Ste C
Las Vegas, NM 87701-4952

Mailing address

PO Box 2694
Las Vegas, NM 87701-2694
Phone (505) 454-1213

Other names 1

  • Physical Therapy Center Doing business as

National Provider Directory

National Provider Directory

Locations

2513 Ridge Runner Rd
Las Vegas, NM 87701
Phone (505) 425-1117

1972 Route 66
Santa Rosa, NM 88435
Phone (575) 472-1213

Practitioners & affiliated clinicians

Practitioners 5

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": "1353110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1174867915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2694",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877012694",
            "telephone_number": "505-454-1213",
            "fax_number": "505-425-2798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1607 7TH ST STE C",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014952",
            "telephone_number": "505-454-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-17",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "KANODE",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_middle_name": "ARDEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-454-1213",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "4234",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NM",
            "license": "4234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.