NPIMap

Organization Active NPI

Proof Physical Therapy and Performance, LLC

  • Orthopedic Physical Therapist
  • Flagstaff, AZ
National Provider Identifier
1841736618
Registry record updated Jan 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
10915 Issued in AZ
Legal business name
PROOF PHYSICAL THERAPY AND PERFORMANCE, LLC
Practice address
460 N Switzer Canyon Dr Ste 400
Flagstaff, AZ 86001-4851
Phone
(928) 440-3106
Fax
(928) 438-6702
NPI assigned
Jan 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2017

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

Authorized official

Name
Jordan WilliamsNPI 1629480512
Title
Sole Member, Physical Therapist
Phone
(928) 440-3106

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X 10915 AZ Primary

Addresses

Primary practice location

460 N Switzer Canyon Dr Ste 400
Flagstaff, AZ 86001-4851

Mailing address

460 N Switzer Canyon Dr Ste 400
Flagstaff, AZ 86001-4851
Phone (928) 440-3106

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170310001709 AZ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2466736400 Receives reassigned benefits from 4 practitioners
Practice locations: Flagstaff, AZ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484784000000",
    "number": "1841736618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 N SWITZER CANYON DR STE 400",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014851",
            "telephone_number": "928-440-3106",
            "fax_number": "928-438-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 N SWITZER CANYON DR STE 400",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014851",
            "telephone_number": "928-440-3106",
            "fax_number": "928-438-6702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROOF PHYSICAL THERAPY AND PERFORMANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-17",
        "last_updated": "2017-01-19",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "SOLE MEMBER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "928-440-3106"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "AZ",
            "license": "10915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; 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.