Individual provider Active NPI

Robert Frank Maffucci, MPT

  • Physical Therapist
  • Redondo Beach, CA
National Provider Identifier
1063426690
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT19890 Issued in CA
Practice address
2621 Manhattan Beach Blvd
Redondo Beach, CA 90278-1604
Phone
(310) 374-0477
Fax
(310) 374-1605
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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 PT19890 CA Primary

Addresses

Primary practice location

2621 Manhattan Beach Blvd
Redondo Beach, CA 90278-1604

Mailing address

2621 Manhattan Beach Blvd
Redondo Beach, CA 90278-1604
Phone (310) 374-0477

Other identifiers 1

IdentifierTypeStateIssuer
PT19890OtherCAPHYSICAL THERAPY LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050209000556 CA Practitioner - Physical Therapist in Private Practice 0941251722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PhysioworksGroup PAC ID 4587670633, 5 clinicians

Practice addresses (Care Compare)

2621 Manhattan Beach Blvd
Redondo Beach, CA 90278-1604
Phone (310) 374-0477

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT19890CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physioworks Physical Therapist CurrentSince Jan 1, 2006 Accepting new patients

Locations

604 N Sepulveda Blvd
Manhattan Beach, CA 90266
Phone (310) 374-0477

2621 Manhattan Beach Blvd
Redondo Beach, CA 90278
Phone (310) 374-0477

Organizations & group practices 1

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1063426690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 MANHATTAN BEACH BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902781604",
            "telephone_number": "310-374-0477",
            "fax_number": "310-374-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 MANHATTAN BEACH BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902781604",
            "telephone_number": "310-374-0477",
            "fax_number": "310-374-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAFFUCCI",
        "first_name": "ROBERT",
        "middle_name": "FRANK",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT19890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT19890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; 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.