Active NPI
Gordon Henriksen
- Physical Therapist
- Aztec, NM
National Provider Identifier
1386916583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2498
- Practice address
- 1607 W Aztec Blvd
Aztec, NM 87410-1805 - Phone
- (505) 334-3695
- NPI assigned
- Feb 2, 2012
- Last updated
- Feb 2, 2012
- Sex
- Male
- Sole proprietor
- No
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 | 2498 | NM | Primary |
Addresses
Primary practice location
1607 W Aztec Blvd
Aztec, NM 87410-1805
Mailing address
2006 Eastlawn Ave
Durango, CO 81301-4835
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2498 | NM | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aztec Municipal School District | Past | Accepting new patients | |
| Aztec Municipal Schools | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- School Social Worker
- Aztec, NM
- NPI 1467856401
-
- Local Education Agency (LEA)
- Aztec, NM
- NPI 1649469271
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328140800000",
"number": "1386916583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2006 EASTLAWN AVE",
"city": "DURANGO",
"state": "CO",
"postal_code": "813014835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1607 W AZTEC BLVD",
"city": "AZTEC",
"state": "NM",
"postal_code": "874101805",
"telephone_number": "505-334-3695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRIKSEN",
"first_name": "GORDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-02",
"last_updated": "2012-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "2498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aztec, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.