Foothills Sports Medicine & Rehabilitation - East Valley Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FOOTHILLS SPORTS MEDICINE & REHABILITATION - EAST VALLEY INC

Doing business as

Foothills Sports Medicine & Rehabilitation - Gilbert-Mesa

Practice address

1702 S Val Vista Dr Ste 107
Mesa, AZ 85204-7304

Phone

(480) 505-8140

Fax

(480) 505-8145

NPI assigned

Jul 28, 2010

Last updated

Dec 31, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Basten

Title

Owner

Phone

(480) 689-5515

Specialties & licenses 3

Addresses

Other names 1

• Foothills Sports Medicine & Rehabilitation - Gilbert-Mesa Doing business as

Locations

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1881908192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15410 S MOUNTAIN PKWY",
            "address_2": "SUITE 112",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850446691",
            "telephone_number": "480-706-1161",
            "fax_number": "480-706-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 S VAL VISTA DR STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047304",
            "telephone_number": "480-505-8140",
            "fax_number": "480-505-8145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS SPORTS MEDICINE & REHABILITATION - EAST VALLEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A",
        "authorized_official_last_name": "BASTEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-689-5515"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Sports Medicine & Rehabilitation - Gilbert-Mesa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Foothills Sports Medicine & Rehabilitation - Gilbert-Mesa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie E Fontaine, P.A.
• Laura Fontaine, MS, EDS, LISAC, LPC
• Foothills Psychiatric Services PLLC
• Foothills Sports Medicine & Physical Therapy - North Mesa LLC
• Foothills Sports Medicine & Physical Therapy - Red Mountain LLC
• Foothills Sports Medicine & Rehabilitation, LLC
• Gabrielle Foppe
• Jennifer Lavonne Forbes, D.C.
• Lauren Faith Forbes
• Todd Cameron Forbes, D.C.

• Physical Therapist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.