Jemez Physical Therapy, PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

JEMEZ PHYSICAL THERAPY, PC

Practice address

2101 Trinity Dr
Ste N
Los Alamos, NM 87544-4103

Phone

(505) 661-6191

Fax

(505) 663-0386

NPI assigned

Jun 14, 2006

Last updated

Oct 24, 2007By 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

Lorraine L Gardner, P.T.NPI 1306824164

Title

President

Phone

(505) 661-6191

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

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.

• Lorraine L Gardner, P.T.

  • Physical Therapist
  • Los Alamos, NM
  • NPI 1306824164
  Authorized official Same address or phone

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1295778470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 TRINITY DR",
            "address_2": "STE N",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875444103",
            "telephone_number": "505-661-6191",
            "fax_number": "505-663-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 TRINITY DR",
            "address_2": "STE N",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875444103",
            "telephone_number": "505-661-6191",
            "fax_number": "505-663-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEMEZ PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "LORRAINE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-661-6191",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "PROVP12945",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NM",
            "identifier": "NM000NA25",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00074159",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Billy Michael Jackson, MD
• Gary Jacques, M.D.
• Jade Therapy, LLC
• Jane Brooks Counseling LLC
• Jemez Mountain Emergency Physicians LLC
• Andrea Johansen, DOM
• Angela Johnson, LCSW
• Timothy J. Johnson, O.D.
• Inez Rowena Jones, DOM
• Mari L Jorgensen, D.P.T

• Physical Therapy Clinic/Center in Los Alamos, NM
• Providers in Los Alamos, NM by specialty
• Physical Therapy Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.