Foothills Sports Medicine & Rehabilitation - East Valley Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

FOOTHILLS SPORTS MEDICINE & REHABILITATION - EAST VALLEY INC

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

Organization subpart

No

Name

Michael Basten

Title

Owner

Phone

(480) 689-5515

Locations

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

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 31, 2020.

{
    "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.

• All providers in Mesa, AZ
• 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.