Active NPI
Lydie Vagnerova
- Physical Therapy Assistant
- Tucson, AZ
National Provider Identifier
1215440953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 10077A
- Practice address
- 1580 E River Rd
Tucson, AZ 85718-7629 - Phone
- (520) 207-2191
- NPI assigned
- Nov 15, 2017
- Last updated
- Nov 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 10077A | AZ | Primary |
Addresses
Primary practice location
1580 E River Rd
Tucson, AZ 85718-7629
Mailing address
1580 E River Rd
Tucson, AZ 85718-7629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10077A | AZ | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Eldercare Rehabilitation Services, LLC | Past | Accepting new patients | |
| Powerback Rehabilitation LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Rehabilitation Clinic/Center
- Tucson, AZ
- NPI 1679984249
-
dba Powerback Rehabilitation
- Physical Therapist
- Woodbridge, VA
- NPI 1790640761
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510704000000",
"number": "1215440953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1580 E RIVER RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857187629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 E RIVER RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857187629",
"telephone_number": "520-207-2191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAGNEROVA",
"first_name": "LYDIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-15",
"last_updated": "2017-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "10077A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.