NPIMap

Organization Active NPI

Sports,Orthopedics & Active Rehabilitation

  • Contractor
National Provider Identifier
1184020653
Registry record updated Nov 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ContractorTaxonomy code 171W00000X
License
PT-37 Issued in GU
Legal business name
SPORTS,ORTHOPEDICS & ACTIVE REHABILITATION
Practice address
224 Farenholt Avenue
Ur 1 Building
Tamuning, GUAM 96913
AX
Phone
(671) 647-0110
NPI assigned
Nov 11, 2014
Last updated
Nov 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2014

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

Authorized official

Name
Mrs. Julienne R. DuenasNPI 1972713402
Title
Physical Therapist
Phone
(671) 647-0110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X PT-37 GU Primary

Addresses

Primary practice location

224 Farenholt Avenue
Ur 1 Building
Tamuning, GUAM 96913
AX

Mailing address

224 Farenholt Avenue
Ur 1 Building
Tamuning, GUAM 96913
AX
Phone (671) 647-0110

National Provider Directory

National Provider Directory
Tax ID family
Soar Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1415664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415664000000",
    "number": "1184020653",
    "addresses": [
        {
            "country_code": "AX",
            "country_name": "Aland Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "224 FARENHOLT AVENUE",
            "address_2": "UR 1 BUILDING",
            "city": "TAMUNING",
            "state": "GUAM",
            "postal_code": "96913",
            "telephone_number": "671-647-0110"
        },
        {
            "country_code": "AX",
            "country_name": "Aland Islands",
            "address_purpose": "LOCATION",
            "address_type": "FGN",
            "address_1": "224 FARENHOLT AVENUE",
            "address_2": "UR 1 BUILDING",
            "city": "TAMUNING",
            "state": "GUAM",
            "postal_code": "96913",
            "telephone_number": "671-647-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS,ORTHOPEDICS & ACTIVE REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-11",
        "last_updated": "2014-11-11",
        "status": "A",
        "authorized_official_last_name": "DUENAS",
        "authorized_official_first_name": "JULIENNE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "671-647-0110",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "GU",
            "license": "PT-37",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.