NPIMap

Organization Active NPI

Physical Therapy Center, Inc.

  • Specialist
  • Longmont, CO
National Provider Identifier
1992876148
Registry record updated Feb 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2550 Issued in CO
Legal business name
PHYSICAL THERAPY CENTER, INC.
Practice address
1330 Sunset St
Longmont, CO 80501-3218
Phone
(303) 776-0333
Fax
(303) 776-0107
NPI assigned
Nov 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2008

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

Authorized official

Name
Mrs. Kim Rivera
Title
Office Manager
Phone
(303) 776-0333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 2550 CO Primary

Addresses

Primary practice location

1330 Sunset St
Longmont, CO 80501-3218

Mailing address

1330 Sunset St
Longmont, CO 80501-3218
Phone (303) 776-0333

Other identifiers 3

IdentifierTypeStateIssuer
193624OtherCODEPT. OF LABOR - WASHINGT
4915543OtherCOCIGNA PIN#
PH654911OtherCOANTHEM BLUE CROSS/SHIELD

Other names 1

  • Patricia Vickland Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040413000592 CO Part B Supplier - Clinic/Group Practice 4284628207 Receives reassigned benefits from 1 practitioner
Practice locations: Longmont, CO

National Provider Directory

National Provider Directory

Locations

1330 Sunset St
Longmont, CO 80501
Phone (303) 776-0333

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1992876148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 SUNSET ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013218",
            "telephone_number": "303-776-0333",
            "fax_number": "303-776-0107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 SUNSET ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805013218",
            "telephone_number": "303-776-0333",
            "fax_number": "303-776-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "303-776-0333",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CO",
            "license": "2550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR - WASHINGT",
            "identifier": "193624",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN#",
            "identifier": "4915543",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS/SHIELD",
            "identifier": "PH654911",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Patricia Vickland",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2008; 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.