NPIMap

Organization Active NPI

Specialized Physical Therapy of Nwa LLC

  • Physical Therapist
  • Rogers, AR
National Provider Identifier
1225670250
Registry record updated Sep 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPECIALIZED PHYSICAL THERAPY OF NWA LLC
Practice address
5001 W Pauline Whitaker Pkwy Ste 120
Rogers, AR 72758-7341
Phone
(479) 202-0337
Fax
(479) 202-0338
NPI assigned
Oct 10, 2019
Last updated
Sep 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2024

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

Authorized official

Name
Mrs. Jacquelyn B Zimmerman, PTNPI 1740237130
Title
Owner/Member
Phone
(402) 981-1406

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 Therapist 225100000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

5001 W Pauline Whitaker Pkwy Ste 120
Rogers, AR 72758-7341

Mailing address

3405 S 117TH St
Omaha, NE 68144-4642
Phone (402) 981-1406

Other practice location 1

701 SW Regional Airport Blvd Unit 13
Bentonville, AR 72713-4589
Phone (479) 370-3782

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200204000971 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1850727298 Receives reassigned benefits from 9 practitioners
Practice locations: Rogers, AR; Bentonville, AR

National Provider Directory

National Provider Directory

Locations

701 SW Regional Airport Blvd
Unit 13
Bentonville, AR 72713
Phone (479) 370-3782

5001 W Pauline Whitaker Pkwy
Ste 120
Rogers, AR 72758
Phone (479) 202-0337

Practitioners & affiliated clinicians

Practitioners 10

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": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1225670250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3405 S 117TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681444642",
            "telephone_number": "402-981-1406",
            "fax_number": "866-304-4838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5001 W PAULINE WHITAKER PKWY STE 120",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727587341",
            "telephone_number": "479-202-0337",
            "fax_number": "479-202-0338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 SW Regional Airport Blvd Unit 13",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727134589",
            "country_code": "US",
            "telephone_number": "479-370-3782",
            "fax_number": "479-202-0338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECIALIZED PHYSICAL THERAPY OF NWA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "402-981-1406",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.