Austin Nosakhare Omwanghe, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT297773 Issued in CA

Practice address

6294 Hidden Brook PL
Etiwanda, CA 91739-9427

Phone

(909) 297-0840

NPI assigned

Aug 30, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Movement Evolved Physical Therapy P.C.

  • Orthopedic Physical Therapist
  • Redlands, CA
  • NPI 1205727146
  NPD

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1063994655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6294 HIDDEN BROOK PL",
            "city": "ETIWANDA",
            "state": "CA",
            "postal_code": "917399427",
            "telephone_number": "909-297-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6294 HIDDEN BROOK PL",
            "city": "ETIWANDA",
            "state": "CA",
            "postal_code": "917399427",
            "telephone_number": "909-297-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMWANGHE",
        "first_name": "AUSTIN",
        "middle_name": "NOSAKHARE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-30",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013536",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT297773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oscar Coracero, ATC
• Crystal Diaz, LMFT
• Etiwanda Esd
• Maria Galvan-Perry, LMFT
• Ashley Lelybell Lopez
• Ram'S Roof
• San Bernardino County Public Health
• Barbara-Jean Gutierrez Santos, M.D.
• Elisa Sequeira, MSW
• Latoya Cheryse Townsend

• Physical Therapist in Etiwanda, CA
• Providers in Etiwanda, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2021; 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.