Individual provider Active NPI

Caroline G. Humberston, PT

  • Physical Therapist
  • Mesa, AZ
National Provider Identifier
1952466575
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6728 Issued in AZ
Practice address
6632 E Baseline Rd
102
Mesa, AZ 85206
Phone
(480) 222-0655
Fax
(480) 222-1457
NPI assigned
Dec 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6728 AZ Primary

Addresses

Primary practice location

6632 E Baseline Rd
102
Mesa, AZ 85206

Mailing address

15455 N Greenway Hayden LP
C16
Scottsdale, AZ 85260
Phone (480) 222-0655

Other identifiers 1

IdentifierTypeStateIssuer
929820MedicaidAZ

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physiosource LTD. Physical Therapist CurrentSince Feb 4, 2013 Accepting new patients
Ati Holdings of Arizona, LLC Physical Therapist PastSince Mar 1, 2016 Accepting new patients
Ideal Rehabilitation LLC Past Accepting new patients
River Rock Rehabilitation, LLC Physical Therapist PastSince Mar 1, 2025 Accepting new patients

Locations

3840 Woodley Rd
Ste D
Toledo, OH 43606
Phone (419) 309-1240

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216598400000",
    "number": "1952466575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15455 N GREENWAY HAYDEN LP",
            "address_2": "C16",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "480-222-0655",
            "fax_number": "480-222-1457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6632 E BASELINE RD",
            "address_2": "102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85206",
            "telephone_number": "480-222-0655",
            "fax_number": "480-222-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBERSTON",
        "first_name": "CAROLINE",
        "middle_name": "G.",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2008-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "6728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "929820",
            "state": "AZ"
        }
    ],
    "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 Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.