Pristine Health LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

2286 Issued in AR

Legal business name

PRISTINE HEALTH LLC

Doing business as

AthletePlus Physical Therapy and Sports Performance

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

Last updated

Mar 16, 2012By the provider in NPPES

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 names 1

• AthletePlus Physical Therapy and Sports Performance Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992996003. Details of each certification follow.

• CCN 046601 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 046601

Legal name

ATHLETEPLUS PHYSICAL THERAPY & SPORTS PERFORMANCE

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jul 22, 2010

Last certification

Aug 22, 2017

Ownership / control type

Proprietary

Facility address

7058 W Sunset Avenue, 9 a
Springdale, AR 72762

Locations

Practitioners 1

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.

• 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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AthletePlus Physical Therapy and Sports Performance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Prince Ventures LLC (Advanced Therapeutic Assist)
• Robin Prince, PHARMD
• Sara Rachel Prine, CRNA
• Heather Camille Prinz
• Rachel Prisco
• Wendy Lynn Privette-Cassady, MS, CCC-SLP
• Professional Remote Oversight Services, LLC
• Megan Provence-Perry, O.D.
• Providence PCC of Springdale
• Psychiatry of Texas PLLC

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.