NPIMap

Organization Active NPI

Impact Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Peoria, AZ
National Provider Identifier
1215319413
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
IMPACT PHYSICAL THERAPY LLC
Practice address
7727 W Deer Valley Rd
Peoria, AZ 85382
Phone
(623) 208-7575
Fax
(866) 281-9664
NPI assigned
Jun 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Dr. Eric Hefferon, DPTNPI 1295061430
Title
Ceo/Owner
Phone
(602) 639-1066

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 7917 AZ
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7727 W Deer Valley Rd
Peoria, AZ 85382

Mailing address

7727 W Deer Valley Rd
Peoria, AZ 85382-2116
Phone (623) 208-7575

Other practice location 1

19420 N 59th Ave
Ste E500
Glendale, AZ 85308-6817
Phone (623) 208-7575

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161014000019 AZ Part B Supplier - Clinic/Group Practice 4789978735 Receives reassigned benefits from 18 practitioners
Practice locations: Peoria, AZ

National Provider Directory

National Provider Directory

Locations

19420 N 59th Ave
Ste E500
Glendale, AZ 85308
Phone (623) 208-7575

7727 W Deer Valley Rd
Peoria, AZ 85382
Phone (623) 208-7575

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1215319413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7727 W DEER VALLEY RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822116",
            "telephone_number": "623-208-7575",
            "fax_number": "866-281-9664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 W DEER VALLEY RD",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85382",
            "telephone_number": "623-208-7575",
            "fax_number": "866-281-9664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19420 N 59th Ave",
            "address_2": "Ste E500",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "AZ",
            "postal_code": "853086817",
            "country_code": "US",
            "telephone_number": "623-208-7575",
            "fax_number": "866-901-0242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-24",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "HEFFERON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "602-639-1066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "7917",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.