Liberated Rehabilitation, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LIBERATED REHABILITATION, PLLC

Practice address

45359 W Paitilla LN
Maricopa, AZ 85139-6714

Phone

(602) 460-8116

NPI assigned

May 25, 2020

Organization subpart

No

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

Authorized official

Name

Jeffrey Nicholson, DPTNPI 1326555178

Title

Owner

Phone

(602) 460-8116

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey A Nicholson Jr., PT, DPT

  • Physical Therapist
  • Maricopa, AZ
  • NPI 1326555178
  Medicare reassignment NPD Authorized official
• Megan Martinez, PT

  • Physical Therapist
  • Marietta, GA
  • NPI 1295415404

  AZ

  Medicare reassignment NPD

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

{
    "created_epoch": "1590364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590364800000",
    "number": "1306469374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45359 W PAITILLA LN",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851396714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45359 W PAITILLA LN",
            "city": "MARICOPA",
            "state": "AZ",
            "postal_code": "851396714",
            "telephone_number": "602-460-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATED REHABILITATION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-25",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-460-8116",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelley Lawrence, O.D.
• Katlyn Brooke Lawson
• William Glenn Lay, D.C.
• Chris G. Le, RRT
• Legacy Healthcare Solutions, Inc.
• Amber Dianne Liermann, LPC
• Life Change Family Services Inc
• Lifestyle Inversion LLC
• Light of Angels
• Lighthouse Family Residential LLC

• Physical Therapist in Maricopa, AZ
• Providers in Maricopa, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2020; 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.