NPIMap

Organization Active NPI

Impact Physical Therapy - 2 LLC

  • Physical Therapy Clinic/Center
  • Scottsdale, AZ
National Provider Identifier
1245895739
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
IMPACT PHYSICAL THERAPY - 2 LLC
Practice address
20801 N Scottsdale Rd Ste 105
Scottsdale, AZ 85255-6487
Phone
(623) 208-7575
NPI assigned
May 9, 2019
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Authorized official

Name
Eric HefferonNPI 1295061430
Title
Authorized Official
Phone
(623) 208-7575

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
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

20801 N Scottsdale Rd Ste 105
Scottsdale, AZ 85255-6487

Mailing address

20801 N Scottsdale Rd Ste 105
Scottsdale, AZ 85255-6487

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220210000690 AZ Part B Supplier - Clinic/Group Practice 8123411360 Receives reassigned benefits from 16 practitioners
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory

Locations

20801 N Scottsdale Rd
Ste 105
Scottsdale, AZ 85255
Phone (623) 208-7575

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1245895739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20801 N SCOTTSDALE RD STE 105",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852556487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20801 N SCOTTSDALE RD STE 105",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852556487",
            "telephone_number": "623-208-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL THERAPY - 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-09",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "HEFFERON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "623-208-7575"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scottsdale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.