NPIMap

Organization Active NPI

Physio Shop Flagstaff LLC

  • Physical Therapy Clinic/Center
  • Flagstaff, AZ
National Provider Identifier
1407674872
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PHYSIO SHOP FLAGSTAFF LLC
Practice address
1510 S Riordan Ranch St
Flagstaff, AZ 86001-6372
Phone
(928) 214-7303
NPI assigned
Oct 2, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Dr. Jason Christopher Dorsch, PTNPI 1023328804
Title
Managing Member/Phyiscal Therapist
Phone
(928) 214-7303

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1510 S Riordan Ranch St
Flagstaff, AZ 86001-6372

Mailing address

1510 S Riordan Ranch St
Flagstaff, AZ 86001-6372
Phone (928) 214-7303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250128001370 AZ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7719416304 Receives reassigned benefits from 6 practitioners
Practice locations: Flagstaff, AZ

National Provider Directory

National Provider Directory

Locations

1510 S Riordan Ranch St
Flagstaff, AZ 86001
Phone (928) 214-7303

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1407674872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S RIORDAN RANCH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860016372",
            "telephone_number": "928-214-7303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S RIORDAN RANCH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860016372",
            "telephone_number": "928-214-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSIO SHOP FLAGSTAFF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "DORSCH",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING MEMBER/PHYISCAL THERAPIST",
        "authorized_official_telephone_number": "928-214-7303",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.