Individual provider Active NPI

Genesis Adriana Villalobos, DPT, PT

  • Physical Therapist
  • Fayetteville, AR
National Provider Identifier
1902558554
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT5040 Issued in AR
Practice address
1261 N Steamboat Dr Ste 2
Fayetteville, AR 72704-6262
Phone
(479) 313-7634
Fax
(479) 313-7650
NPI assigned
Jan 25, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT5040 AR Primary

Addresses

Primary practice location

1261 N Steamboat Dr Ste 2
Fayetteville, AR 72704-6262

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220404000641 AR Practitioner - Physical Therapist in Private Practice 4082000856 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT5040ARMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Serc Rehabilitation Partners, LLC Physical Therapist CurrentSince Mar 7, 2022 Accepting new patients
Serc Rebabilitation Partners, LLC Physical Therapist CurrentSince Mar 7, 2022 Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1261 N Steamboat Dr
Ste 2
Fayetteville, AR 72704
Phone (479) 313-6591

2603 W Pleasant Grove Rd
Ste 104
Rogers, AR 72758
Phone (479) 636-1187

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1902558554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 N STEAMBOAT DR STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727046262",
            "telephone_number": "479-313-7634",
            "fax_number": "479-313-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLALOBOS",
        "first_name": "GENESIS",
        "middle_name": "ADRIANA",
        "credential": "DPT, PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT5040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.