NPIMap

Organization Active NPI

East Valley Physical Therapy & Aquatic Rehabilitation LTD

  • Physical Therapy Clinic/Center
  • Mesa, AZ
National Provider Identifier
1912095936
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
EAST VALLEY PHYSICAL THERAPY & AQUATIC REHABILITATION LTD
Practice address
217 S 63Rd St Ste 101
Mesa, AZ 85206-6106
Phone
(480) 981-0900
Fax
(480) 981-0897
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Authorized official

Name
Janell Keller
Title
Office Manager
Phone
(480) 981-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

217 S 63Rd St Ste 101
Mesa, AZ 85206-6106

Mailing address

217 S 63Rd St Ste 101
Mesa, AZ 85206-6106
Phone (480) 981-0900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000640 AZ Part B Supplier - Clinic/Group Practice 8628966629 Receives reassigned benefits from 6 practitioners
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Locations

217 S 63rd St
Mesa, AZ 85206

217 S 63rd St
Ste 101
Mesa, AZ 85206
Phone (480) 981-0900

3411 N 5th Ave
Ste 508
Phoenix, AZ 85013
Phone (602) 264-0443

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1912095936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 S 63RD ST STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852066106",
            "telephone_number": "480-981-0900",
            "fax_number": "480-981-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S 63RD ST STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852066106",
            "telephone_number": "480-981-0900",
            "fax_number": "480-981-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY PHYSICAL THERAPY & AQUATIC REHABILITATION LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "JANELL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "480-981-0900"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 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.