Active NPI
Amador Physical Therapy, Inc.
- Physical Therapist
- Jackson, CA
National Provider Identifier
1023067022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- AMADOR PHYSICAL THERAPY, INC.
- Practice address
- 813 Court St
Ste2
Jackson, CA 95642-2131 - Phone
- (209) 223-3250
- Fax
- (209) 223-2517
- NPI assigned
- May 8, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jolynn Grijalva, P.T.
- Title
- Office Manager
- Phone
- (209) 223-3250
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
813 Court St
Ste2
Jackson, CA 95642-2131
Mailing address
813 Court St
Ste2
Jackson, CA 95642-2131
Phone (209) 223-3250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ54629Z | Other | CA | BLUE SHIELD |
| 650008609 | Other | CA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070710000964 | CA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 9032219720 |
Receives reassigned benefits from 3 practitioners Practice locations: Jackson, CA |
National Provider Directory
National Provider DirectoryLocations
813 Court St
Jackson, CA 95642
Phone (209) 223-3250
813 Court St
Ste 2
Jackson, CA 95642
Phone (209) 223-3250
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Jackon, CA
- NPI 1316996747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1264032000000",
"number": "1023067022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 COURT ST",
"address_2": "STE2",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422131",
"telephone_number": "209-223-3250",
"fax_number": "209-223-2517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 COURT ST",
"address_2": "STE2",
"city": "JACKSON",
"state": "CA",
"postal_code": "956422131",
"telephone_number": "209-223-3250",
"fax_number": "209-223-2517"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMADOR PHYSICAL THERAPY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-08",
"last_updated": "2010-01-21",
"status": "A",
"authorized_official_last_name": "GRIJALVA",
"authorized_official_first_name": "JOLYNN",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "209-223-3250",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "P.T."
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "ZZZ54629Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "650008609",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, CA
- Amador County Office of Education
- Amador County Office of Education
- Amador Emergency Physicians Medical Group, Inc.
- Amador Family Physicians Medical
- Amador Fire Protection District
- Amador Regional Transit
- Amador Surgery Center
- Amador-Tuolumne Community Action Agency
- American Heritage Pharmacy Inc
- American Heritage Pharmacy Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.