PARK MEDICAL PHYSICAL THERAPY, PROF CORP (NPI# 1295904308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295904308 |
| Entity Type | Organization |
| Organization Name | PARK MEDICAL PHYSICAL THERAPY, PROF CORP |
| Practice Address |
4120 W Point Loma Blvd San Diego CA 92110-5605 |
| Mailing Address |
4136 Bachman Pl San Diego CA 92103-2028 |
| Practice Telephone | 6192972544 |
| Practice Fax Number | 6192972752 |
| Mailing Telephone | 6192972544 |
| Mailing Fax Number | 6192972752 |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-27 |
| Authorized Official Name | LINDA JOYCE CHRISTENSEN (PRESIDENT/OWNER) |
| Authorized Official Telephone | 6192972544 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
PT7388 | CA | Suppliers |
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | PT7388 | CA | Suppliers |
| Y | 335E00000X | Prosthetic/Orthotic Supplier | PT7388 | CA | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376661579 | Park Medical Physical Therapy, Prof Corp | Clinic/Center | 4120 W Point Loma Blvd, San Diego, CA 92110-5605 | 2007-03-26 |
| Street Address |
4120 W POINT LOMA BLVD |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92110-5605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760447536 | Mary Lydia Engles | Physical Therapist | 4120 W Point Loma Blvd, San Diego, CA 92110-5605 | 2006-04-17 |
| 1376661579 | Park Medical Physical Therapy, Prof Corp | Clinic/Center | 4120 W Point Loma Blvd, San Diego, CA 92110-5605 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669021713 | Ruben Daniel Gutierrez | Marriage & Family Therapist | 4141 Pacific Coast Hwy, San Diego, CA 92110 | 2019-09-10 |
| 1548724081 | Denise Ellen Thompson | Counselor | 3255 Wings Street, San Diego, CA 92110 | 2019-01-29 |
| 1801378716 | Michelle Lisa Jean Crawford | Student in an Organized Health Care Education/Training Program | 3767 Central Avenue, San Diego, CA 92110 | 2018-09-06 |
| 1427539048 | Allison Turrell | Case Manager/Care Coordinator | 4930 Naples Street, San Diego, CA 92110 | 2018-08-22 |
| 1750872768 | Matthew Langworthy | Physical Therapist | 3405 Kenyon St Ste 212, San Diego, CA 92110 | 2018-05-24 |
| 1245748342 | The One Health Boutique, LLC | Chiropractor | 5350 Riley St, San Diego, CA 92110 | 2018-01-11 |
| 1437670155 | Monique A Fernandez | Counselor | 3132 Jefferson Street, San Diego, CA 92110 | 2017-07-03 |
| 1538510391 | Mayu Winters | Registered Nurse | 853 Rosecrans St, San Diego, CA 92110 | 2016-06-23 |
| 1376998864 | Briniti Ichull | Specialist | 3941 Kurtz St, San Diego, CA 92110 | 2016-05-03 |
| 1912352576 | Healthcare Services, Inc. | Substance Abuse Rehabilitation Facility | 3880 Rosecrans Street, San Diego, CA 92110 | 2016-05-02 |
| Find all providers in zip 92110 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154815025 | Alcam Medical Inc. | Prosthetic/Orthotic Supplier | 6244 El Cajon Blvd Ste 12, San Diego, CA 92115-3918 | 2018-06-14 |
| 1215484720 | Telehealth Clinical Services | Prosthetic/Orthotic Supplier | 2667 Camino Del Rio South #207, San Diego, CA 92108-3765 | 2016-09-01 |
| 1770931438 | A Greater Hope | Prosthetic/Orthotic Supplier | 2515 Camino Del Rio S Ste 242a, San Diego, CA 92108-3715 | 2016-06-02 |
| 1649638701 | Norell Prosthetics Orthotics Inc. | Prosthetic/Orthotic Supplier | 5466 Complex St Ste 207, San Diego, CA 92123-1124 | 2016-02-04 |
| 1194132795 | Annadon, Inc. | Prosthetic/Orthotic Supplier | 4079 Governor Dr, Suite 700, San Diego, CA 92122-2522 | 2014-07-15 |
| 1487945739 | Ruthiva LLC | Prosthetic/Orthotic Supplier | 10601 Tierrasanta Blvd, Ste G-188, San Diego, CA 92124-2616 | 2011-04-20 |
| 1952609661 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 7910 Frost St Ste 320, San Diego, CA 92123 | 2011-03-03 |
| 1518147289 | Precision Medical, Inc. | Prosthetic/Orthotic Supplier | 4424 44th St, Suite 315, San Diego, CA 92115-4300 | 2007-11-09 |
| 1508911173 | J & J Artificial Limb & Brace LLC | Prosthetic/Orthotic Supplier | 11411 W Bernardo Ct., San Diego, CA 92127 | 2007-01-24 |
| 1508876442 | Carlos Valenzuela | Prosthetic/Orthotic Supplier | 4224 Ohio St, San Diego, CA 92104-1320 | 2006-08-09 |
| Find all providers in SAN DIEGO | ||||
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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.