NPIMap

Organization Active NPI

Spectra Sports Medicine & Physical Therapy, LP

  • Physical Therapist
  • Lubbock, TX
National Provider Identifier
1679522866
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPECTRA SPORTS MEDICINE & PHYSICAL THERAPY, LP
Practice address
6801 Indiana Ave
Lubbock, TX 79413-6109
Phone
(806) 785-7900
Fax
(806) 785-7909
NPI assigned
May 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Authorized official

Name
Mr. Leslie D Glenn, PTNPI 1396794855
Title
Co-Owner
Phone
(806) 785-7900

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

6801 Indiana Ave
Lubbock, TX 79413-6109

Mailing address

6801 Indiana Ave
Lubbock, TX 79413-6109
Phone (806) 785-7900

Other practice location 1

5244 114th St
Lubbock, TX 79424
Phone (806) 785-7900

Other identifiers 2

IdentifierTypeStateIssuer
0072KXOtherTXBLUE CROSS BLUE SHIELD
7970614OtherTXAETNA

Other names 1

  • Fyzical Therapy & Balance Centers Lubbock Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000537 TX Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5395723514 Receives reassigned benefits from 6 practitioners
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory

Locations

6801 Indiana Ave
Lubbock, TX 79413
Phone (806) 785-7900

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1679522866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 INDIANA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794136109",
            "telephone_number": "806-785-7900",
            "fax_number": "806-785-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 INDIANA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794136109",
            "telephone_number": "806-785-7900",
            "fax_number": "806-785-7909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5244 114th St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "79424",
            "country_code": "US",
            "telephone_number": "806-785-7900",
            "fax_number": "806-785-7909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRA SPORTS MEDICINE & PHYSICAL THERAPY, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "806-785-7900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0072KX",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7970614",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fyzical Therapy & Balance Centers Lubbock",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fyzical Therapy & Balance Centers Lubbock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 28, 2023; 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.