Individual provider Active NPI

Caleb Lionberger, PTA, ATC

  • Physical Therapy Assistant
  • Peoria, AZ
National Provider Identifier
1265679807
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
7528A Issued in AZ
Practice address
8685 W Union Hills Dr
Peoria, AZ 85382-7006
Phone
(623) 486-2331
NPI assigned
Jan 20, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 7528A AZ Primary
Athletic Trainer 2255A2300X 1137 AZ

Addresses

Primary practice location

8685 W Union Hills Dr
Peoria, AZ 85382-7006

Mailing address

5188 W Campo Bello Dr
Glendale, AZ 85308-3925

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

LicenseStateTypeSpecialty
7528AAZMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SLK Inc PastSince Jun 8, 2015 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1265679807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5188 W CAMPO BELLO DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853083925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8685 W UNION HILLS DR",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853827006",
            "telephone_number": "623-486-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIONBERGER",
        "first_name": "CALEB",
        "credential": "PTA, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-20",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "7528A",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1137",
            "primary": false
        }
    ],
    "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 Jun 25, 2015; 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.