NPIMap

Organization Active NPI

Sports Injury Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Pasadena, CA
National Provider Identifier
1073603858
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
WPT14957B Issued in CA
Legal business name
SPORTS INJURY PHYSICAL THERAPY, INC
Practice address
801 S Raymond Ave
Pasadena, CA 91105-3223
Phone
(626) 356-0599
Fax
(626) 356-0570
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Authorized official

Name
Mr. Kevin Lee Wentz, P.T.NPI 1861581795
Title
Owner
Phone
(626) 356-0599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X WPT14957B CA Primary
Physical Therapy Clinic/Center 261QP2000X WPT21776B CA
Physical Therapy Clinic/Center 261QP2000X WPT27120B CA
Physical Therapy Clinic/Center 261QP2000X WPT20125B CA

Addresses

Primary practice location

801 S Raymond Ave
Pasadena, CA 91105-3223

Mailing address

801 S Raymond Ave
Pasadena, CA 91105-3223
Phone (626) 356-0599

Other names 1

  • Professional Orthopedic and Sports Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050722000322 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1658308572 Receives reassigned benefits from 8 practitioners
Practice locations: Pasadena, CA

National Provider Directory

National Provider Directory

Locations

753 S Arroyo Pkwy
Pasadena, CA 91105
Phone (626) 356-0599

801 S Raymond Ave
Pasadena, CA 91105
Phone (626) 356-0599

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1073603858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S RAYMOND AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053223",
            "telephone_number": "626-356-0599",
            "fax_number": "626-356-0570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S RAYMOND AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053223",
            "telephone_number": "626-356-0599",
            "fax_number": "626-356-0570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS INJURY PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "WENTZ",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-356-0599",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "WPT14957B",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "WPT21776B",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "WPT27120B",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "WPT20125B",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Orthopedic and Sports Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; 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.

Verify at the official NPI Registry.