Mark Luck Lito Villa Cubillas, RPT
Individual provider Active NPI Physical Therapist · Sonoma, CA
NPI 1083388581 · NPPES record last updated Aug 6, 2021
Key facts
- NPI
- 1083388581
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 294596 (CA)
- Practice address
- 1250 Broadway
Sonoma, CA 95476-7500 - Phone
- (707) 938-8406
- NPI assigned
- Aug 6, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- San Ramon Valley Physical Therapy Inc
Practice addresses (Care Compare)
12677 Alcosta Blvd
Suite 150
San Ramon, CA 94583-4423
Phone (925) 355-1900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220406001924 | CA | Practitioner - Physical Therapist in Private Practice | 0941696777 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 294596 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Ramon Valley Physical Therapy Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
917 San Ramon Valley Blvd
Ste 190
Danville, CA 94526
Phone (925) 552-5787
12677 Alcosta Blvd
Ste 150
San Ramon, CA 94583
Phone (925) 355-1900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 294596 | CA | Yes |
Addresses
Primary practice location
1250 Broadway
Sonoma, CA 95476-7500
Mailing address
885 Broadway Apt 9
Sonoma, CA 95476-7027
Phone (415) 629-2020
Other providers in Sonoma, CA
- Susie Cook
- April Cooke
- Lisa Corsello
- County of Sonoma
- Crawford Medical Transport & Logistics LLC
- Jody Alison Culp
- Richard Lee Daffurn
- Kayla A Dale
- Barry Robert Danieli
- Jennifer K Darby
All providers in Sonoma, CA · Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.