Active NPI
Elizabeth Provost, PT
- Physical Therapist
- Albuquerque, NM
National Provider Identifier
1730328501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 633
- Practice address
- 2211 Lomas Blvd NE
Albuquerque, NM 87106-2745 - Phone
- (505) 272-9870
- Fax
- (505) 272-8079
- NPI assigned
- Feb 18, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 633 | NM | Primary |
Addresses
Primary practice location
2211 Lomas Blvd NE
Albuquerque, NM 87106-2745
Mailing address
1650 University Blvd NE
Suite 116
Albuquerque, NM 87102-1726
Phone (505) 272-9870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 633 | NM | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234915200000",
"number": "1730328501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 UNIVERSITY BLVD NE",
"address_2": "SUITE 116",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871021726",
"telephone_number": "505-272-9870",
"fax_number": "505-272-8079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 LOMAS BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062745",
"telephone_number": "505-272-9870",
"fax_number": "505-272-8079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVOST",
"first_name": "ELIZABETH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-02-18",
"last_updated": "2009-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "633",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.