Orthomed LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ORTHOMED LLC

Doing business as

PROACTIVE PHYSICAL THERPY

Practice address

3945 E Paradise Falls Dr
Ste 109
Tucson, AZ 85712-6683

Phone

(520) 321-0204

Fax

(520) 321-0495

NPI assigned

Jun 9, 2008

Organization subpart

No

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

Authorized official

Name

Serena Lewis

Title

Administrator

Phone

(520) 829-7712

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PROACTIVE PHYSICAL THERPY Doing business as

Locations

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1386803807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64207",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857284207",
            "telephone_number": "520-829-7712",
            "fax_number": "520-314-4121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3945 E PARADISE FALLS DR",
            "address_2": "STE 109",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857126683",
            "telephone_number": "520-321-0204",
            "fax_number": "520-321-0495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "SERENA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "520-829-7712"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "825036",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROACTIVE PHYSICAL THERPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.