Active NPI
Brian James Rewalt, PT
- Physical Therapist
- Las Cruces, NM
National Provider Identifier
1326223330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2059
- Practice address
- 2455 Missouri Ave
Las Cruces, NM 88001-5122 - Phone
- (575) 522-5852
- NPI assigned
- Jan 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2059 | NM | Primary |
Addresses
Primary practice location
2455 Missouri Ave
Las Cruces, NM 88001-5122
Mailing address
2455 Missouri Ave
Las Cruces, NM 88001-5122
Phone (575) 522-5852
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2059 | NM | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199836800000",
"number": "1326223330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 MISSOURI AVE",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880015122",
"telephone_number": "575-522-5852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2455 MISSOURI AVE",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880015122",
"telephone_number": "575-522-5852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REWALT",
"first_name": "BRIAN",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-09",
"last_updated": "2008-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "2059",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.