Corephysio LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6440 Issued in AZ

Legal business name

COREPHYSIO LLC

Practice address

1017 S Gilbert Rd
Suite 104
Mesa, AZ 85204-4442

Phone

(480) 507-0130

Fax

(480) 507-0135

NPI assigned

Feb 9, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Carlos Raoul Reeberg, P.T

Title

Managing Director

Phone

(480) 507-0130

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1902138431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 S GILBERT RD",
            "address_2": "SUITE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044442",
            "telephone_number": "480-507-0130",
            "fax_number": "480-507-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 S GILBERT RD",
            "address_2": "SUITE 104",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852044442",
            "telephone_number": "480-507-0130",
            "fax_number": "480-507-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COREPHYSIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-09",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "REEBERG",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_middle_name": "RAOUL",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "480-507-0130",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1114905254",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Mesa, AZ
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• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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.