Pristine Health LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2286 Issued in AR

Legal business name

PRISTINE HEALTH LLC

Practice address

7058 W Sunset Ave
Suite 9a
Springdale, AR 72762-0680

Phone

(479) 751-8437

Fax

(479) 802-0575

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Daniel Chris CothernNPI 1871694471

Title

Owner/Physical Therapist

Phone

(479) 751-8437

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• AthletePlus Physical Therapy and Sports Performance Doing business as

Practitioners 1

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

• Daniel Cothern

  • Specialist
  • Fayetteville, AR
  • NPI 1871694471

  Physical Therapy

  NPD Authorized official

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1992996003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7058 W SUNSET AVE",
            "address_2": "SUITE 9A",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727620680",
            "telephone_number": "479-751-8437",
            "fax_number": "479-802-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7058 W SUNSET AVE",
            "address_2": "SUITE 9A",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727620680",
            "telephone_number": "479-751-8437",
            "fax_number": "479-802-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "COTHERN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "479-751-8437",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AR",
            "license": "2286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163436721",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5A004",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "046601",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AthletePlus Physical Therapy and Sports Performance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Springdale, AR
• Providers in Springdale, AR by specialty
• Physical Therapy Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.