NPIMap

Organization Active NPI

Refined Form Physical Therapy, PLLC

  • Physical Therapist
  • Crestone, CO
National Provider Identifier
1619601978
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REFINED FORM PHYSICAL THERAPY, PLLC
Practice address
3704 Carefree Way
Crestone, CO 81131-0404
Phone
(360) 713-7938
NPI assigned
Jul 13, 2022
Last updated
Mar 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Jennifer Walkowski, DPTNPI 1316395619
Title
Owner / Founder
Phone
(719) 204-3434

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3704 Carefree Way
Crestone, CO 81131-0404

Mailing address

PO Box 404
Crestone, CO 81131-0404
Phone (719) 204-3434

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jenn@refinedformpt.com

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26915/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jenn@refinedformpt.com

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1619601978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 404",
            "city": "CRESTONE",
            "state": "CO",
            "postal_code": "811310404",
            "telephone_number": "719-204-3434",
            "fax_number": "833-464-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 CAREFREE WAY",
            "city": "CRESTONE",
            "state": "CO",
            "postal_code": "811310404",
            "telephone_number": "360-713-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REFINED FORM PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "WALKOWSKI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER / FOUNDER",
        "authorized_official_telephone_number": "719-204-3434",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jenn@refinedformpt.com",
            "affiliation": "N",
            "address_1": "3704 Carefree Way",
            "city": "Crestone",
            "state": "CO",
            "country_code": "US",
            "postal_code": "811310404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crestone, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.