Gaia Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6380 Issued in CO

Legal business name

GAIA PHYSICAL THERAPY

Practice address

1919 65TH Ave
Suite #3
Greeley, CO 80634

Phone

(970) 302-4322

Fax

(888) 432-0938

NPI assigned

Nov 8, 2010

Last updated

Jul 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Havice Conlin, M.P.T.NPI 1265687180

Title

Physical Therapist Owner

Phone

(970) 302-4322

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 1

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.

• Michelle Havice Conlin, M.P.T.

  • Physical Therapist
  • Greeley, CO
  • NPI 1265687180
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531699200000",
    "number": "1467753483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 65TH AVE STE COFFICE2",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806347965",
            "telephone_number": "970-302-4322",
            "fax_number": "888-432-0938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 65TH AVE",
            "address_2": "SUITE #3",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "80634",
            "telephone_number": "970-302-4322",
            "fax_number": "888-432-0938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAIA PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-08",
        "last_updated": "2018-07-16",
        "status": "A",
        "authorized_official_last_name": "CONLIN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "HAVICE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST OWNER",
        "authorized_official_telephone_number": "970-302-4322",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "6380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10776231",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pamola Sue Gale, FNP-C
• Rocio A Galindo, PEER
• Kelly Gall
• Anthony Gallegos-Nelson
• Jemalie Gallegos

• Physical Therapist in Greeley, CO
• Providers in Greeley, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2018; 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.