NPIMap

Organization Active NPI

Tipton Physical Therapy, LLC

Doing business as Tipton Physical Therapy and Aquatic Center

  • Physical Therapist
  • Prescott Valley, AZ
National Provider Identifier
1811954803
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5049 Issued in AZ
Legal business name
TIPTON PHYSICAL THERAPY, LLC
Doing business as
Tipton Physical Therapy and Aquatic Center
Practice address
8400 E Florentine Rd
Prescott Valley, AZ 86314-8653
Phone
(928) 775-9999
Fax
(928) 775-9998
NPI assigned
Apr 26, 2006
Reactivated
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

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

Authorized official

Name
Ms. Anita Ann Phelps
Title
Medical Billing
Phone
(928) 775-9999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 5049 AZ Primary

Addresses

Primary practice location

8400 E Florentine Rd
Prescott Valley, AZ 86314-8653

Mailing address

8400 E Florentine Rd
Prescott Valley, AZ 86314-8653
Phone (928) 775-9999

Other identifiers 6

IdentifierTypeStateIssuer
115AZ60188OtherAZTRIWEST DCN
3Z2680OtherAZHEALTHNET
670847OtherAZUNITED HEALTHCARE
707440OtherAZWELLCARE
191587MedicaidAZ
106263700OtherAZDEPT OF LABOR

Other names 1

  • Tipton Physical Therapy and Aquatic Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040604000881 AZ Part B Supplier - Clinic/Group Practice 2567444292 Receives reassigned benefits from 4 practitioners
Practice locations: Prescott Valley, AZ

National Provider Directory

National Provider Directory

Locations

8400 E Florentine Rd
Ste 104
Prescott Vly, AZ 86314
Phone (928) 541-9477

8400 E Florentine Rd
Prescott Vly, AZ 86314
Phone (928) 541-9477

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536537600000",
    "number": "1811954803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148653",
            "telephone_number": "928-775-9999",
            "fax_number": "928-775-9998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8400 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148653",
            "telephone_number": "928-775-9999",
            "fax_number": "928-775-9998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIPTON PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2018-09-10",
        "deactivation_date": "2006-07-17",
        "reactivation_date": "2006-08-30",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "ANITA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MEDICAL BILLING",
        "authorized_official_telephone_number": "928-775-9999",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "5049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST DCN",
            "identifier": "115AZ60188",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3Z2680",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "670847",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "707440",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191587",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "106263700",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tipton Physical Therapy and Aquatic Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tipton Physical Therapy and Aquatic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; 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.