Individual provider Active NPI

Joellen K Qualls, PT

  • Physical Therapist
  • Lubbock, TX
National Provider Identifier
1669643516
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1135663 Issued in TX
Practice address
4601 66TH St
Suite D
Lubbock, TX 79414-4828
Phone
(806) 793-3900
Fax
(806) 793-3937
NPI assigned
Mar 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1135663 TX Primary

Addresses

Primary practice location

4601 66TH St
Suite D
Lubbock, TX 79414-4828

Mailing address

1806 Quincy St
Plainview, TX 79072-4206
Phone (806) 288-7891

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190724001619 TX Practitioner - Physical Therapist in Private Practice 6901132281

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1135663TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
West Texas Family Medicine, PLLC CurrentSince Jun 5, 2019 Accepting new patients

Locations

1806 Quincy St
Plainview, TX 79072
Phone (806) 288-7891

1605 W 5th St
Plainview, TX 79072
Phone (806) 288-7891

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1669643516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 QUINCY ST",
            "city": "PLAINVIEW",
            "state": "TX",
            "postal_code": "790724206",
            "telephone_number": "806-288-7891",
            "fax_number": "806-288-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 66TH ST",
            "address_2": "SUITE D",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794144828",
            "telephone_number": "806-793-3900",
            "fax_number": "806-793-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLS",
        "first_name": "JOELLEN",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-19",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1135663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.