Active NPI
Mario Vincent Diaz, DPT
- Physical Therapist
- Phoenix, AZ
National Provider Identifier
1932761228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30719
- Practice address
- 20045 N 19TH Ave BLDG 8
Phoenix, AZ 85027-4267 - Phone
- (623) 594-9034
- NPI assigned
- Jul 8, 2019
- 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 | 30719 | AZ | Primary |
Addresses
Primary practice location
20045 N 19TH Ave BLDG 8
Phoenix, AZ 85027-4267
Mailing address
20045 N 19TH Ave BLDG 8
Phoenix, AZ 85027-4267
Phone (623) 594-9034
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 |
|---|---|---|---|
| 30719 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BHSM Rehabilitation, LLC | Past | Accepting new patients | |
| BHSM Rehabilitation, LLC | Past | Accepting new patients |
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.
-
- Physical Therapy Clinic/Center
- Glendale, AZ
- NPI 1235654237
-
- Physical Therapy Clinic/Center
- Peoria, AZ
- NPI 1285271684
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1932761228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20045 N 19TH AVE BLDG 8",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850274267",
"telephone_number": "623-594-9034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20045 N 19TH AVE BLDG 8",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850274267",
"telephone_number": "623-594-9034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "MARIO",
"middle_name": "VINCENT",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-08",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "30719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.