NPIMap

Organization Active NPI

Vail Physical Therapy, LLC

  • Physical Therapist
  • Vail, CO
National Provider Identifier
1376162883
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
VAIL PHYSICAL THERAPY, LLC
Practice address
1295 Westhaven Dr
Vail, CO 81657-4395
Phone
(970) 476-7510
Fax
(970) 476-7511
NPI assigned
Apr 14, 2020
Last updated
Apr 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Jennifer MartinNPI 1023072188
Title
Owner
Phone
(612) 799-9192

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 NU Primary

Addresses

Primary practice location

1295 Westhaven Dr
Vail, CO 81657-4395

Mailing address

570 Homestead Dr Apt 38
Edwards, CO 81632-8162

Other practice location 1

570 Homestead Dr Apt 38
Edwards, CO 81632-8162
Phone (612) 799-9192

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200501000099 CO Part B Supplier - Clinic/Group Practice 9537599790 Receives reassigned benefits from 1 practitioner
Practice locations: Vail, CO

National Provider Directory

National Provider Directory

Locations

1295 Westhaven Dr
Vail, CO 81657
Phone (970) 476-7510

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1586822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1376162883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 HOMESTEAD DR APT 38",
            "city": "EDWARDS",
            "state": "CO",
            "postal_code": "816328162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1295 WESTHAVEN DR",
            "city": "VAIL",
            "state": "CO",
            "postal_code": "816574395",
            "telephone_number": "970-476-7510",
            "fax_number": "970-476-7511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "570 Homestead Dr Apt 38",
            "address_purpose": "LOCATION",
            "city": "Edwards",
            "state": "CO",
            "postal_code": "816328162",
            "country_code": "US",
            "telephone_number": "612-799-9192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VAIL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-14",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-799-9192"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vail, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; 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.