AGAVE PHYSICAL THERAPY LLC
NPI 1720521040
Clinic/Center - Physical Therapy in Lake Havasu City, AZ

Active since November 18, 2016
191 SWANSON AVE, #102, LAKE HAVASU CITY, AZ 86403(928) 855-7880(928) 855-7881 Get Directions Write a Review

NPPES record last updated: December 13, 2016. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 13, 2016, Nov 22, 2016, Nov 18, 2016 (3 updates tracked since 2016).

About Agave Physical Therapy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGAVE PHYSICAL THERAPY LLC (NPI 1720521040) is a healthcare organization registered as a physical therapy in Lake Havasu City, Arizona and active in the NPI registry since November 2016. The organization lists Brett Qualls, Owner, as its authorized official.

NPPES Registry Identity

NPI1720521040
Entity TypeOrganization
Primary Taxonomy261QP2000X
Legal Business NameAGAVE PHYSICAL THERAPY LLC
Location Address191 SWANSON AVE, #102Lake Havasu City, AZ 86403-6699
Mailing Address191 Swanson Ave, #102Lake Havasu City, AZ 86403-6699 · (928) 855-7880 · Fax (928) 855-7881
Fax(928) 855-7881
Organization SubpartNo
Authorized OfficialBrett QuallsOwner · (928) 855-7880
Enumeration DateNovember 18, 2016
Last NPPES UpdateDecember 13, 20163 updates tracked since enumeration
✔ NPI 1720521040 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Physical TherapyAmbulatory Health Care Facilities
Taxonomy Code261QP2000X
Definition
An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists and physical therapist assistants are licensed health care professionals who are experts in the movement system and help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance.
191 SWANSON AVE, Lake Havasu City, AZ 86403

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Agave Physical Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Agave Physical Therapy LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Physical Therapist in Private Practice
NPI 1215105630
191 SWANSON AVE #102
Lake Havasu City, AZ 86403
(928) 855-7880
✔ Accepts MedicareSame address
Physical Therapist in Private Practice
NPI 1235309311
11071 S. CAMELBACK ROAD
Yucca, AZ 86438
(928) 279-3652
32 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Agave Physical Therapy LLC's NPI number?

The NPI number for Agave Physical Therapy LLC is 1720521040. It was assigned to this organization in the NPPES registry on November 18, 2016.

Where is Agave Physical Therapy LLC located?

Agave Physical Therapy LLC is located at 191 Swanson Ave #102, Lake Havasu City, AZ 86403. The listed phone number is (928) 855-7880.

What is Agave Physical Therapy LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Physical Therapy, with taxonomy code 261QP2000X.

Is Agave Physical Therapy LLC enrolled in Medicare?

Yes. Agave Physical Therapy LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Agave Physical Therapy LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Agave Physical Therapy LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Agave Physical Therapy LLC accept?

Health plans from Blue Cross Blue Shield of Arizona and Cigna HealthCare of Arizona, Inc list Agave Physical Therapy LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Agave Physical Therapy LLC was last updated on December 13, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.