La Plata Physical Medicine PC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LA PLATA PHYSICAL MEDICINE PC

Practice address

555 Rivergate LN Ste B1-101
Durango, CO 81301-7470

Phone

(970) 403-3324

Fax

(833) 975-0954

NPI assigned

Apr 7, 2019

Organization subpart

No

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

Authorized official

Name

Robert S Wallach, DONPI 1730247149

Title

Owner

Phone

(970) 403-3324

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/21595/brand/1/csg/1/fhir/r4

Practitioners 2

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

• Robert S Wallach, DO

  • Physical Medicine & Rehabilitation Physician
  • Durango, CO
  • NPI 1730247149
  Medicare reassignment NPD Authorized official
• Sejal S Quayle, M.D.

  • Urology Physician
  • Durango, CO
  • NPI 1538156484
  NPD

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

{
    "created_epoch": "1554595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1689137754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 RIVERGATE LN STE B1-101",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017470",
            "telephone_number": "970-403-3324",
            "fax_number": "833-975-0954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 RIVERGATE LN STE B1-101",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017470",
            "telephone_number": "970-403-3324",
            "fax_number": "833-975-0954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PLATA PHYSICAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-07",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "WALLACH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "970-403-3324",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anita R Kumar, MD
• Cassidy Evelyn Kurry
• Dara Sophia La Madrid
• La Plata Family Counseling, PLLC
• La Plata Family Medicine Assoc PC
• Clayton Thomas Labaume, PA
• Laboratory Corporation of America
• Laboratory Corporation of America
• William Earl Lacey Jr., DMD
• Ginny Ann Laidler, RN

• Physical Medicine & Rehabilitation Physician in Durango, CO
• Providers in Durango, CO by specialty
• Physical Medicine & Rehabilitation Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.