NPIMap

Organization Active NPI

Socorro Physical Therapy Incorporated

  • Physical Therapist
  • Socorro, NM
National Provider Identifier
1669498556
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3059 Issued in NM
Legal business name
SOCORRO PHYSICAL THERAPY INCORPORATED
Practice address
911B N California St
Socorro, NM 87801-4269
Phone
(575) 838-1000
Fax
(575) 838-2000
NPI assigned
Jul 14, 2006
Last updated
Jun 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Authorized official

Name
Kelby Heath Stephens, PTNPI 1083633853
Title
President
Phone
(575) 838-1000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 3059 NM Primary
Occupational Therapist 225X00000X 2067 NM

Addresses

Primary practice location

911B N California St
Socorro, NM 87801-4269

Mailing address

911B N California St
Socorro, NM 87801-4269
Phone (575) 838-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110405001162 NM Part B Supplier - Clinic/Group Practice 9638353220 Receives reassigned benefits from 3 practitioners
Practice locations: Socorro, NM

National Provider Directory

National Provider Directory

Locations

911 N California St
Socorro, NM 87801
Phone (575) 838-1000

911 N California St
#B
Socorro, NM 87801
Phone (505) 838-1000

Practitioners & affiliated clinicians

Practitioners 7

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1669498556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911B N CALIFORNIA ST",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014269",
            "telephone_number": "575-838-1000",
            "fax_number": "575-838-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911B N CALIFORNIA ST",
            "city": "SOCORRO",
            "state": "NM",
            "postal_code": "878014269",
            "telephone_number": "575-838-1000",
            "fax_number": "575-838-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCORRO PHYSICAL THERAPY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "KELBY",
        "authorized_official_middle_name": "HEATH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "575-838-1000",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "3059",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NM",
            "license": "2067",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Socorro, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.