Individual provider Active NPI

Jan-Bernard Manalang Aquino, PT, DPT

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1053077354
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
301206 Issued in CA
Practice address
5478 Wilshire Blvd Ste 208
Los Angeles, CA 90036-4225
Phone
(323) 936-7525
NPI assigned
Nov 10, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 301206 CA Primary

Addresses

Primary practice location

5478 Wilshire Blvd Ste 208
Los Angeles, CA 90036-4225

Mailing address

16121 Blackhawk St
Granada Hills, CA 91344-7007
Phone (818) 427-6172

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211118001751 CA Practitioner - Physical Therapist in Private Practice 9032508726 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians
Stay Ready IncGroup PAC ID 5395840466, 8 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

5478 Wilshire Blvd
Suite 208
Los Angeles, CA 90036-4225
Phone (323) 936-7525

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
301206CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stay Ready Inc Physical Therapist CurrentSince Nov 11, 2021 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince May 16, 2025 Accepting new patients
Body Rehab Center Physical Therapist PastSince Nov 11, 2021 Accepting new patients

Locations

17323 Ventura Blvd
Ste 100
Encino, CA 91316
Phone (323) 936-7525

5478 Wilshire Blvd
Ste 208
Los Angeles, CA 90036
Phone (323) 936-7525

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1053077354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16121 BLACKHAWK ST",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913447007",
            "telephone_number": "818-427-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5478 WILSHIRE BLVD STE 208",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900364225",
            "telephone_number": "323-936-7525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AQUINO",
        "first_name": "JAN-BERNARD",
        "middle_name": "MANALANG",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "301206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.