Active NPI
Trailhead Health & Rehab LLC
- Physical Therapy Clinic/Center
- Phoenix, AZ
National Provider Identifier
1568079523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- Legal business name
- TRAILHEAD HEALTH & REHAB LLC
- Practice address
- 1838 W Parkside LN Ste 110
Phoenix, AZ 85027-1370 - Phone
- (970) 712-2938
- NPI assigned
- Sep 24, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Blaine Stimac
- Title
- Managing Member
- Phone
- (406) 756-1128
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapy Clinic/Center | 261QP2000X | Primary |
Addresses
Primary practice location
1838 W Parkside LN Ste 110
Phoenix, AZ 85027-1370
Mailing address
PO Box 5718
Kalispell, MT 59903-5718
Phone (406) 756-0134
Other names 1
- Trailhead Physical Therapy & Sports Medicine
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201207000799 | AZ | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 8022420512 |
Receives reassigned benefits from 3 practitioners Practice locations: Phoenix, AZ |
National Provider Directory
National Provider DirectoryLocations
1838 W Parkside Ln
Ste 110
Phoenix, AZ 85027
Phone (480) 454-4698
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695081600000",
"number": "1568079523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5718",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599035718",
"telephone_number": "406-756-0134",
"fax_number": "406-300-1612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1838 W PARKSIDE LN STE 110",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850271370",
"telephone_number": "970-712-2938"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRAILHEAD HEALTH & REHAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-09-24",
"last_updated": "2023-09-19",
"certification_date": "2023-09-19",
"status": "A",
"authorized_official_last_name": "STIMAC",
"authorized_official_first_name": "BLAINE",
"authorized_official_title_or_position": "MANAGING MEMBER",
"authorized_official_telephone_number": "406-756-1128"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Trailhead Physical Therapy & Sports Medicine",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Trailhead Physical Therapy & Sports Medicine",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; 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.