Individual provider Active NPI

Alex Lagrutta, PT

  • Physical Therapist
  • Fayetteville, AR
National Provider Identifier
1720807423
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT5492 Issued in AR
Practice address
3399 Black Forest Dr Ste 3
Fayetteville, AR 72704-6541
Phone
(479) 435-6712
NPI assigned
Oct 9, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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 PT5492 AR Primary

Addresses

Primary practice location

3399 Black Forest Dr Ste 3
Fayetteville, AR 72704-6541

Mailing address

1148 W Riverdale Dr
Nixa, MO 65714-8255
Phone (417) 300-9965

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241205003447 AR Practitioner - Physical Therapist in Private Practice 0244766848 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Physical Therapy LLCGroup PAC ID 5395032882, 13 clinicians

Practice addresses (Care Compare)

3399 Black Forest Dr
Suite 3
Fayetteville, AR 72704-6541
Phone (479) 340-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT5492ARMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Physical Therapy LLC Physical Therapist CurrentSince Oct 17, 2024 Accepting new patients

Locations

3399 Black Forest Dr
Ste 3
Fayetteville, AR 72704
Phone (479) 340-1100

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": "1728432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1720807423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 W RIVERDALE DR",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657148255",
            "telephone_number": "417-300-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3399 BLACK FOREST DR STE 3",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727046541",
            "telephone_number": "479-435-6712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGRUTTA",
        "first_name": "ALEX",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-09",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT5492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.