NPIMap

Organization Active NPI

Mountain Laurel Physical Therapy and Rehabilitation

Doing business as Mountain Laurel Physical Therapy

  • Physical Therapist
  • Clive, IA
National Provider Identifier
1891498671
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MOUNTAIN LAUREL PHYSICAL THERAPY AND REHABILITATION
Doing business as
Mountain Laurel Physical Therapy
Practice address
8365 University Blvd
Clive, IA 50325-1124
Phone
(515) 473-4725
NPI assigned
Mar 22, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
Dr. Annette Smith, PT, DPTNPI 1003461690
Title
Doctor of Physical Therapy/Owner
Phone
(515) 473-4725

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

8365 University Blvd
Clive, IA 50325-1124

Mailing address

10574 Greenbelt Dr
Clive, IA 50325-6617
Phone (515) 473-4725

Other names 1

  • Mountain Laurel Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231212001250 IA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7911356274 Receives reassigned benefits from 5 practitioners
Practice locations: Clive, IA; West Des Moines, IA

National Provider Directory

National Provider Directory

Locations

8365 University Blvd
Clive, IA 50325
Phone (515) 473-4725

974 73rd St
Ste 33
West Des Moines, IA 50265
Phone (515) 223-4146

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1891498671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10574 GREENBELT DR",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503256617",
            "telephone_number": "515-473-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8365 UNIVERSITY BLVD",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "503251124",
            "telephone_number": "515-473-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAUREL PHYSICAL THERAPY AND REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-12-08",
        "certification_date": "2023-11-30",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "DOCTOR OF PHYSICAL THERAPY/OWNER",
        "authorized_official_telephone_number": "515-473-4725",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Laurel Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Laurel Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clive, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; 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.