NPIMap

Organization Active NPI

Advanced Neurologic Rehabilitation

  • Physical Therapy Clinic/Center
  • Chandler, AZ
National Provider Identifier
1922482017
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
9343 Issued in AZ
Legal business name
ADVANCED NEUROLOGIC REHABILITATION
Practice address
3160 N. Arizona Ave
Suite 106
Chandler, AZ 85225
Phone
(480) 699-4845
Fax
(480) 699-5085
NPI assigned
Jul 17, 2015
Last updated
Jul 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Authorized official

Name
Mr. Jefferson Wayne Holm, PT, DPTNPI 1740622109
Title
Owner
Phone
(480) 699-4845

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 9343 AZ Primary

Addresses

Primary practice location

3160 N. Arizona Ave
Suite 106
Chandler, AZ 85225

Mailing address

3160 N. Arizona Ave
Suite 106
Chandler, AZ 85225
Phone (480) 699-4845

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151112001859 AZ Part B Supplier - Clinic/Group Practice 5395055859 Receives reassigned benefits from 49 practitioners
Practice locations: Gilbert, AZ; Scottsdale, AZ; Chandler, AZ

National Provider Directory

National Provider Directory
Tax ID family
Advanced Neurologic Rehab3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3160 N Arizona Ave
Ste 106
Chandler, AZ 85225
Phone (480) 613-7184

1447 W Elliot Rd
Ste 101
Gilbert, AZ 85233
Phone (480) 699-4845

3961 E Guadalupe Rd
Ste 1
Gilbert, AZ 85234
Phone (480) 699-4845

3961 E Guadalupe Rd
Ste 170
Gilbert, AZ 85234

10601 N Frank Lloyd Wright Blvd
Ste 100
Scottsdale, AZ 85259
Phone (480) 319-7159

Practitioners & affiliated clinicians

Practitioners 56

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.

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595894400000",
    "number": "1922482017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3160 N. ARIZONA AVE",
            "address_2": "SUITE 106",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85225",
            "telephone_number": "480-699-4845",
            "fax_number": "480-699-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3160 N. ARIZONA AVE",
            "address_2": "SUITE 106",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85225",
            "telephone_number": "480-699-4845",
            "fax_number": "480-699-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED NEUROLOGIC REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A",
        "authorized_official_last_name": "HOLM",
        "authorized_official_first_name": "JEFFERSON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-699-4845",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "9343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2020; 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.