Primitive Therapy Physical Therapy Inc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PRIMITIVE THERAPY PHYSICAL THERAPY INC

Practice address

22691 Lambert St Ste 520
Lake Forest, CA 92630-1614

Phone

(949) 310-4276

Fax

(888) 390-1433

NPI assigned

Aug 11, 2009

Last updated

Dec 7, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Matthew Caldwell, DPTNPI 1750561775

Title

Owner

Phone

(949) 310-4276

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob M Caldwell, RPT

  • Physical Therapist
  • Lake Forest, CA
  • NPI 1750561775
  NPD (past) Authorized official

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260144000000",
    "number": "1083846976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22691 LAMBERT ST #520",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301614",
            "telephone_number": "949-310-4276",
            "fax_number": "888-390-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22691 LAMBERT ST STE 520",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301614",
            "telephone_number": "949-310-4276",
            "fax_number": "888-390-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMITIVE THERAPY PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-11",
        "last_updated": "2009-12-07",
        "status": "A",
        "authorized_official_last_name": "CALDWELL",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-310-4276",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CL344A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Preventive Nutrition for Life, LLC
• Alyssa Price, D.C.
• Stefanie Price
• Monte George Pries, PHD
• Christian Marie Prietto, M.A.
• Carlli Pruitt
• Quality Senior Placement Specialists
• Soledad Quartucci
• Lori Anna Quigley, PH.D.
• Amy Ward Quinn, M.A., IMF

• Physical Therapy Clinic/Center in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2009; 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.