Active NPI
Carly Lena, P.T.
- Physical Therapist
- Phoenix, AZ
National Provider Identifier
1356717060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7139
- Practice address
- 1802 W Parkside LN
Phoenix, AZ 85027-1322 - Phone
- (602) 943-5472
- NPI assigned
- Aug 17, 2015
- Sex
- Female
- 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 | 7139 | AZ | Primary |
Addresses
Primary practice location
1802 W Parkside LN
Phoenix, AZ 85027-1322
Mailing address
7228 W Pontiac Dr
Glendale, AZ 85308-9628
Phone (623) 866-3035
Other names 1
- Carly Lena Mollineaux
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 |
|---|---|---|---|
| 7139 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Futures, LLC | Physical Therapist | Past | Accepting new patients |
| United Cerebral Palsy Association of Central Arizona | Physical Therapist | Past | Accepting new patients |
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.
-
- Developmentally Disabled Services Day Training Agency
- Phoenix, AZ
- NPI 1982673992
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439769600000",
"number": "1356717060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7228 W PONTIAC DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853089628",
"telephone_number": "623-866-3035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 W PARKSIDE LN",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850271322",
"telephone_number": "602-943-5472"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LENA",
"first_name": "CARLY",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-17",
"last_updated": "2015-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "7139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CARLY",
"last_name": "MOLLINEAUX",
"middle_name": "LENA",
"credential": "P.T.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.