Individual provider Active NPI

Todd Waterkotte, DPT

  • Physical Therapist
  • Mesa, AZ
National Provider Identifier
1427064575
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
LPT-012133 Issued in AZ
Practice address
8427 E Baseline Rd
Mesa, AZ 85209-4378
Phone
(480) 306-6627
Fax
(480) 306-6696
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-010262 IL
Physical Therapist 225100000X LPT-012133 AZ Primary

Addresses

Primary practice location

8427 E Baseline Rd
Mesa, AZ 85209-4378

Mailing address

6512 E Sharon Dr Ste 100
Scottsdale, AZ 85254-3948
Phone (217) 617-1895

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160602001429 AZ Practitioner - Physical Therapist in Private Practice 4284687385 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic and Sport Rehab Specialists at Anthem LLCGroup PAC ID 8527961978, 32 clinicians

Practice addresses (Care Compare)

14202 N Scottsdale Rd
Suite 169
Scottsdale, AZ 85254-4081
Phone (480) 265-2122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPT-012133AZMDPhysical Therapist
070-010262ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Modern Sports Medicine LLC CurrentSince Nov 1, 2024 Accepting new patients
Brian F. Gruber, M.D., LTD Physical Therapist CurrentSince Nov 13, 2017 Accepting new patients
Modern Sports Medicine LLC Physical Therapist CurrentSince Nov 1, 2024 Accepting new patients
Advance PT Therapy of Hannibal LLC Physical Therapist PastSince Aug 8, 2012 Accepting new patients
Bloom Physical Therapy, LLC Physical Therapist PastSince Nov 24, 2024 Accepting new patients
Neurosurgical Associates, LTD Physical Therapist PastSince Nov 13, 2017 Accepting new patients

Locations

5590 W Chandler Blvd
Ste 4
Chandler, AZ 85226
Phone (480) 786-4969

8427 E Baseline Rd
Ste 101
Mesa, AZ 85209
Phone (480) 357-6500

8427 E Baseline Rd
Mesa, AZ 85209

20940 N Tatum Blvd
Ste B290
Phoenix, AZ 85050
Phone (602) 734-1826

17300 N Perimeter Dr
Ste 150
Scottsdale, AZ 85255
Phone (602) 734-1826

10450 E Riggs Rd
Ste 104
Sun Lakes, AZ 85248
Phone (612) 888-5224

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1427064575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6512 E SHARON DR STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852543948",
            "telephone_number": "217-617-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8427 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852094378",
            "telephone_number": "480-306-6627",
            "fax_number": "480-306-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERKOTTE",
        "first_name": "TODD",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-010262",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-012133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.