NPIMap

Organization Active NPI

Spectrum Spine and Sport Physical Therapy LLC

  • Physical Therapist
  • Gilbert, AZ
National Provider Identifier
1942467501
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SPECTRUM SPINE AND SPORT PHYSICAL THERAPY LLC
Practice address
3485 S Mercy Rd
Suite 101
Gilbert, AZ 85297-0429
Phone
(480) 963-2400
NPI assigned
May 21, 2008
Last updated
Nov 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Authorized official

Name
Stacey L. Billyard, P.T.NPI 1114965175
Title
Owner/Physical Therapist
Phone
(480) 963-2400

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

3485 S Mercy Rd
Suite 101
Gilbert, AZ 85297-0429

Mailing address

3485 S Mercy Rd
Suite 101
Gilbert, AZ 85297-0429
Phone (480) 963-2400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080828000039 AZ Part B Supplier - Clinic/Group Practice 7214003276 Receives reassigned benefits from 7 practitioners
Practice locations: Gilbert, AZ

National Provider Directory

National Provider Directory

Locations

3485 S Mercy Rd
Ste 101
Gilbert, AZ 85297
Phone (480) 507-2044

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1942467501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 S MERCY RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970429",
            "telephone_number": "480-963-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3485 S MERCY RD",
            "address_2": "SUITE 101",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970429",
            "telephone_number": "480-963-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM SPINE AND SPORT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "BILLYARD",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "480-963-2400",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.