Enliven Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ENLIVEN PHYSICAL THERAPY LLC

Practice address

20914 W Granada Rd
Buckeye, AZ 85396-6582

Phone

(480) 923-9554

Fax

(480) 573-9556

NPI assigned

Mar 19, 2020

Last updated

Oct 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cary Edgar

Title

Authorized Official

Phone

(480) 206-6240

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1225664576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20914 W GRANADA RD",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853966582",
            "telephone_number": "480-923-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20914 W GRANADA RD",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853966582",
            "telephone_number": "480-923-9554",
            "fax_number": "480-573-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLIVEN PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "EDGAR",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-206-6240"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; 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.