NPIMap

Organization Active NPI

Southland Physical Therapy Mission Viejo Clinic, PC

  • Physical Therapist
  • Mission Viejo, CA
National Provider Identifier
1023569795
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40531 Issued in CA
Legal business name
SOUTHLAND PHYSICAL THERAPY MISSION VIEJO CLINIC, PC
Practice address
25565 Jeronimo Rd
Mission Viejo, CA 92691-2707
Phone
(949) 627-8800
Fax
(949) 627-8801
NPI assigned
Oct 18, 2016
Organization subpart
Yes
Parent organization
SOUTHLAND PHYSICAL THERAPY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shawn Jeffrey Mead, DPT
Title
Clinical Manager
Phone
(949) 627-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 40531 CA Primary

Addresses

Primary practice location

25565 Jeronimo Rd
Mission Viejo, CA 92691-2707

Mailing address

25565 Jeronimo Rd
Mission Viejo, CA 92691-2707
Phone (949) 627-8800

Other names 1

  • Southland Physical Therapy Doing business as

National Provider Directory

National Provider Directory
Part of
Southland Physical Therapy

Locations

25565 Jeronimo Rd
Mission Viejo, CA 92691
Phone (949) 627-8800

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1023569795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25565 JERONIMO RD",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912707",
            "telephone_number": "949-627-8800",
            "fax_number": "949-627-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25565 JERONIMO RD",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912707",
            "telephone_number": "949-627-8800",
            "fax_number": "949-627-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND PHYSICAL THERAPY MISSION VIEJO CLINIC, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHLAND PHYSICAL THERAPY, INC",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "MEAD",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "CLINICAL MANAGER",
        "authorized_official_telephone_number": "949-627-8800",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "40531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southland Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.