Golden Years Physical Therapy LLC

Primary specialty

Geriatric Physical TherapistTaxonomy code 2251G0304X

Legal business name

GOLDEN YEARS PHYSICAL THERAPY LLC

Practice address

11453 E Reuben Ave
Mesa, AZ 85212-4113

Phone

(425) 750-9526

NPI assigned

Nov 13, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Jennifer Lee Derham, PT, DPTNPI 1720124357

Title

Physical Therapist

Phone

(425) 750-9526

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

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

• Jennifer Lee Derham, DPT

  • Physical Therapist
  • Arlington, WA
  • NPI 1720124357

  AZ

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1699833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1306610100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11453 E REUBEN AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852124113",
            "telephone_number": "425-750-9526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11453 E REUBEN AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852124113",
            "telephone_number": "425-750-9526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN YEARS PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-13",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-12",
        "status": "A",
        "authorized_official_last_name": "DERHAM",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "425-750-9526",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Daniel Goldberg, MD
• Amanda Lael Golde, LMT
• Golden Health at Home Personal Care Services LLC
• Golden Rose Hospice Care Inc
• Golden Years Care Home, LLC
• Jeanne Golden
• Goldfield Medical Clinics, LLC (Goldfield Cardiovascular Institue)
• Goldfield Mountain Healthcare LLC (Alta Mesa Health and Rehabilitation)
• Goldfield Mountain Healthcare LLC (Alta Mesa Health and Rehabilitation)
• Goldfield Mountain Healthcare LLC

• Geriatric Physical Therapist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Geriatric Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; 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.