NPIMap

Organization Active NPI

River Valley Therapy & Sports Medicine Inc

  • Physical Therapist
  • Russellville, AR
National Provider Identifier
1619925732
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
RIVER VALLEY THERAPY & SPORTS MEDICINE INC
Practice address
2100 W Main St
Russellville, AR 72801-2758
Phone
(479) 968-2525
Fax
(479) 968-2538
NPI assigned
May 4, 2006
Last updated
Jun 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Authorized official

Name
Gabe Freyaldenhoven, P.T.NPI 1609825975
Title
Owner
Phone
(479) 968-2525

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 Therapist 225100000X NU Primary

Addresses

Primary practice location

2100 W Main St
Russellville, AR 72801-2758

Mailing address

2100 W Main St
Russellville, AR 72801-2758
Phone (479) 968-2525

Other identifiers 5

IdentifierTypeStateIssuer
5C556OtherARBLUE CROSS BLUE SHIELD
662725OtherARHEALTHLINK
DA9917OtherARPALMETTO GI RAILROAD
A001OtherARTRICARE
145301742MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040127001051 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1850294018 Receives reassigned benefits from 33 practitioners
Practice locations: Dardanelle, AR; Russellville, AR
O20100930068666 AR DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 1850294018 Practice locations: Russellville, AR
O20251209000311 OK Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1850294018 Receives reassigned benefits from 3 practitioners
Practice locations: Idabel, OK

National Provider Directory

National Provider Directory

Locations

309 Union St
Dardanelle, AR 72834
Phone (479) 229-5151

2100 W Main St
Russellville, AR 72801
Phone (479) 968-2525

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560297600000",
    "number": "1619925732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012758",
            "telephone_number": "479-968-2525",
            "fax_number": "479-968-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012758",
            "telephone_number": "479-968-2525",
            "fax_number": "479-968-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER VALLEY THERAPY & SPORTS MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2019-06-12",
        "status": "A",
        "authorized_official_last_name": "FREYALDENHOVEN",
        "authorized_official_first_name": "GABE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-968-2525",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5C556",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "662725",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GI RAILROAD",
            "identifier": "DA9917",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145301742",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2019; 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.