Individual provider Active NPI

Jonathan Paul Vales, DPT

  • Physical Therapist
  • Hammond, LA
National Provider Identifier
1356074918
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
11270 Issued in LA
Practice address
1100 C M Fagan Dr Ste 103
Hammond, LA 70403-5963
Phone
(985) 542-6664
Fax
(985) 542-6428
NPI assigned
Jul 1, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 11270 LA Primary

Addresses

Primary practice location

1100 C M Fagan Dr Ste 103
Hammond, LA 70403-5963

Mailing address

1100 C M Fagan Dr Ste 103
Hammond, LA 70403-5963
Phone (985) 542-6664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220812000860 LA Practitioner - Physical Therapist in Private Practice 3577946250 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Anatomix Physical Therapy-Mandeville LLC Physical Therapist CurrentSince Aug 4, 2022 Accepting new patients
Anatomix Physical Therapy Inc Physical Therapist CurrentSince Aug 4, 2022 Accepting new patients

Locations

1100 C M Fagan Dr
Ste 103
Hammond, LA 70403
Phone (985) 542-6664

3916 Highway 22
Ste 3
Mandeville, LA 70471
Phone (985) 542-6664

Organizations & group practices 2

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": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1356074918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 C M FAGAN DR STE 103",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704035963",
            "telephone_number": "985-542-6664",
            "fax_number": "985-542-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 C M FAGAN DR STE 103",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704035963",
            "telephone_number": "985-542-6664",
            "fax_number": "985-542-6428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALES",
        "first_name": "JONATHAN",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-01",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "11270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; 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.