Active NPI
Pawat Poupongtong, DPT
- Physical Therapist
- Buckeye, AZ
National Provider Identifier
1902407976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30798
- Practice address
- 23350 W Yuma Rd
Buckeye, AZ 85326-3106 - Phone
- (623) 242-6908
- NPI assigned
- Nov 5, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 30798 | AZ | Primary |
Addresses
Primary practice location
23350 W Yuma Rd
Buckeye, AZ 85326-3106
Mailing address
17830 N 45TH Ave
Glendale, AZ 85308-1650
Phone (562) 455-3886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30798 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604534400000",
"number": "1902407976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17830 N 45TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853081650",
"telephone_number": "562-455-3886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23350 W YUMA RD",
"city": "BUCKEYE",
"state": "AZ",
"postal_code": "853263106",
"telephone_number": "623-242-6908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POUPONGTONG",
"first_name": "PAWAT",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-05",
"last_updated": "2020-11-05",
"certification_date": "2020-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "30798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buckeye, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.