JKL Restorative PLLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

JKL RESTORATIVE PLLC

Practice address

5652 E Baseline Rd
Mesa, AZ 85206-4713

Phone

(480) 567-0350

NPI assigned

Jan 3, 2024

Last updated

Jan 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Lopez, DONPI 1245692706

Title

Owner & Physician

Phone

(443) 974-6166

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

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.

• John Lopez, DO

  • Physical Medicine & Rehabilitation Physician
  • Mesa, AZ
  • NPI 1245692706
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1704240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1912777624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8102 E CYPRESS ST",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852572815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5652 E BASELINE RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064713",
            "telephone_number": "480-567-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JKL RESTORATIVE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-03",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER & PHYSICIAN",
        "authorized_official_telephone_number": "443-974-6166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; 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.