NPIMap

Organization Active NPI

White Tanks Physical Therapy and Orthopedic Rehabilitation LLC

  • Specialist
  • Goodyear, AZ
National Provider Identifier
1194808600
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
WHITE TANKS PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION LLC
Practice address
250 N Litchfield Rd
Suite 155
Goodyear, AZ 85338-1333
Phone
(623) 882-9787
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Pablo Ruiz Jr., P.T.NPI 1326043175
Title
Owner/Physical Therapist
Phone
(623) 882-9787

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X AZ Primary

Addresses

Primary practice location

250 N Litchfield Rd
Suite 155
Goodyear, AZ 85338-1333

Mailing address

250 N Litchfield Rd
Suite 155
Goodyear, AZ 85338-1333
Phone (623) 882-9787

Other identifiers 5

IdentifierTypeStateIssuer
64-0096OtherAZEVERCARE AHCCS
7499498OtherAZAETNA ID
2Z2985OtherHUMANA
AZ0299850OtherAZBC/BS OF AZ
3786840000OtherAZDEPT. OF LABOR

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040526001051 AZ Part B Supplier - Clinic/Group Practice 9638150584 Receives reassigned benefits from 7 practitioners
Practice locations: Goodyear, AZ

National Provider Directory

National Provider Directory
Tax ID family
White Tanks Physical Therapy and Orthope2 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.

Locations

250 N Litchfield Rd
Ste 155
Goodyear, AZ 85338
Phone (623) 882-9787

Practitioners & affiliated clinicians

Practitioners 7

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": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194808600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N LITCHFIELD RD",
            "address_2": "SUITE 155",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381333",
            "telephone_number": "623-882-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N LITCHFIELD RD",
            "address_2": "SUITE 155",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853381333",
            "telephone_number": "623-882-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE TANKS PHYSICAL THERAPY AND ORTHOPEDIC REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "PABLO",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "623-882-9787",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE AHCCS",
            "identifier": "64-0096",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA ID",
            "identifier": "7499498",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "2Z2985",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF AZ",
            "identifier": "AZ0299850",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR",
            "identifier": "3786840000",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.