NPIMap

Organization Active NPI

Great Basin Physical Therapy and Performance Center

  • Physical Therapist
  • Minden, NV
National Provider Identifier
1366769234
Registry record updated Sep 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2193 Issued in NV
Legal business name
GREAT BASIN PHYSICAL THERAPY AND PERFORMANCE CENTER
Practice address
1701 County Rd
Suite B
Minden, NV 89423-4464
Phone
(775) 782-4466
NPI assigned
Apr 30, 2010
Last updated
Sep 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2015

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

Authorized official

Name
Ashwin T Datt, PTNPI 1437336492
Title
Sole Member
Phone
(831) 238-5217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2193 NV Primary

Addresses

Primary practice location

1701 County Rd
Suite B
Minden, NV 89423-4464

Mailing address

PO Box 34120
Reno, NV 89533-4120
Phone (775) 747-5050

Other identifiers 2

IdentifierTypeStateIssuer
34615OtherCAPHYSICAL THERAPY BOARD OF CALIFORNIA
2193OtherNVBOARD OF PHYSICAL THERAPY EXAMINERS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100517000186 NV Part B Supplier - Clinic/Group Practice 6305974007 Receives reassigned benefits from 3 practitioners
Practice locations: Minden, NV

National Provider Directory

National Provider Directory

Locations

1701 County Rd
Minden, NV 89423
Phone (775) 322-3269

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441238400000",
    "number": "1366769234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34120",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895334120",
            "telephone_number": "775-747-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 COUNTY RD",
            "address_2": "SUITE B",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "894234464",
            "telephone_number": "775-782-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BASIN PHYSICAL THERAPY AND PERFORMANCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2015-09-03",
        "status": "A",
        "authorized_official_last_name": "DATT",
        "authorized_official_first_name": "ASHWIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "831-238-5217",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "2193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY BOARD OF CALIFORNIA",
            "identifier": "34615",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHYSICAL THERAPY EXAMINERS",
            "identifier": "2193",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minden, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; 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.