Nellyn Bautista

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

4201 Central Ave NW Ste K3
Albuquerque, NM 87105-1647

Phone

(505) 508-1739

NPI assigned

Jan 22, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1679103253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 CENTRAL AVE NW STE K3",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871051647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 CENTRAL AVE NW STE K3",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871051647",
            "telephone_number": "505-508-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "NELLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHONE NUMBER",
            "identifier": "5055072862",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ALBUQUERQUE",
            "affiliation": "N",
            "address_1": "4201 Central Ave NW Ste K3",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871051647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Steven Keith Baum, PHD
• Michael Bauman, MD
• Rosemary Laurel Bauman, LCSW
• Angela Genette Baumeister, PA-C
• Alice J. Baumstark, O.D.
• Alisha Bavin
• Ina Townley Bawaya, LCSW, MFA
• Kristyn Lenore Bawol, RD
• Amelia Reeve Baxter-Stoltzfus
• Bonnie M Baxter, NP

• Physical Therapist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.