ANOCHA SUPHOL (NPI# 1003031899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003031899 |
| Entity Type | Individual |
| Full Name | ANOCHA SUPHOL |
| Credential | MPT |
| Practice Address |
4444 Magnolia Ave Riverside CA 92501-4136 |
| Practice Telephone | 9512743524 |
| Practice Fax Number | 9512743442 |
| Mailing Telephone | 9512743524 |
| Mailing Fax Number | 9512743442 |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2251S0007X |
Physical Therapist Specialization: Sports |
PT27871 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| X | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
PT27871 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4444 MAGNOLIA AVE |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92501-4136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164407391 | Thomas Mark Hartley | Orthopaedic Surgery | 4444 Magnolia Ave, Riverside, CA 92501 | 2005-12-09 |
| 1295175479 | James David Winn | Physical Therapy Assistant | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2013-07-02 |
| 1710131750 | Danica C Macias | Physical Medicine & Rehabilitation | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2008-11-04 |
| 1932389673 | Christy Jo Horn | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-11-09 |
| 1942497193 | Thomas Tuan Pham | Family Medicine | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-10-02 |
| 1902024169 | Brent Harper | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-23 |
| 1629293428 | Margery Sanchez | Occupational Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-16 |
| 1639394414 | Kim Samosky | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-16 |
| 1245455104 | Theodora Winn | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-16 |
| 1275608937 | Community Medical Group of Riverside Inc | Family Medicine | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2006-11-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437605 | Mary Horvatin | Technician | 1811 Rivera Strret, Riverside, CA 92501 | 2019-09-23 |
| 1366905473 | Timothy Daniel Collins | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme, Office, Riverside, CA 92501 | 2019-04-08 |
| 1346709672 | Lourdes Adame | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave - Gme Office, Riverside, CA 92501 | 2019-03-16 |
| 1740759067 | Kristina Ferris-celosse | Counselor | 2452 Wilshire St., Riverside, CA 92501 | 2018-11-15 |
| 1750888095 | Arunmozhi Aravagiri | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, Gme Office, 4445 Magnolia Ave., Riverside, CA 92501 | 2018-04-12 |
| 1720585847 | Alan Huynh | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue., Gme Office, Riverside, CA 92501 | 2018-04-06 |
| 1538664834 | Wilson Paul Frasca | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue, Riverside, CA 92501 | 2018-03-28 |
| 1851896575 | Geethu Gopinathan Nair | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme Office, Riverside, CA 92501 | 2018-03-26 |
| 1316465560 | Thilini Anne Abeygunaratne | Marriage & Family Therapist | 1950 Market Street, Riverside, CA 92501 | 2017-09-07 |
| 1194257410 | Melissa Chitwood | Assistant Behavior Analyst | 3078 Cedar St., Riverside, CA 92501 | 2017-03-28 |
| Find all providers in zip 92501 | ||||
| Taxonomy Code | 2251S0007X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Sports |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902024169 | Brent Harper | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-23 |
| 1639394414 | Kim Samosky | Physical Therapist | 4444 Magnolia Ave, Riverside, CA 92501-4136 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104443837 | Coastal Physical Therapy and Sports Rehabilitation | Physical Therapist | 258 Lombard St, Thousand Oaks, CA 91360-5806 | 2020-06-29 |
| 1992335509 | Ashton Pickle | Physical Therapist | 150 Loma Ln, San Clemente, CA 92672-4721 | 2020-01-23 |
| 1083262976 | Lana Aziz-oglii | Physical Therapist | 2791 Brimhall Dr, Los Alamitos, CA 90720-4905 | 2019-09-03 |
| 1174080931 | Mmt Physical Therapy Inc | Physical Therapist | 3040 Larkin St, San Francisco, CA 94109-1116 | 2019-02-27 |
| 1649737982 | La Orthopedic and Pediatric Physical Therapy | Physical Therapist | 16055 Ventura Blvd Ste 825, Encino, CA 91436-2617 | 2019-02-22 |
| 1225505894 | Haley Tarryn Hawes | Physical Therapist | 12401 Wilshire Blvd Ste 105, Los Angeles, CA 90025-1015 | 2018-10-31 |
| 1629561667 | Jason Chan Hyung Park | Physical Therapist | 2440 W Carson St, Torrance, CA 90501-3146 | 2018-06-13 |
| 1447757125 | Anthony G Tam | Physical Therapist | 5030 Bonita Rd Ste B, Bonita, CA 91902-1700 | 2018-04-10 |
| 1730606468 | Joseph Anthony Santistevan | Physical Therapist | 1975 Maricopa Hwy Spc 19, Ojai, CA 93023-2365 | 2017-08-24 |
| 1124541016 | Max Biessmann | Physical Therapist | 28202 Cabot Rd Ste 150, Laguna Niguel, CA 92677-1250 | 2017-07-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.