NPIMap

Organization Active NPI

Ultimate Physical Therapy and Rehabilitation Clinic Inc

  • Physical Therapist
  • Rosemead, CA
National Provider Identifier
1104023464
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ULTIMATE PHYSICAL THERAPY AND REHABILITATION CLINIC INC
Practice address
2630 San Gabriel Blvd
Suite 104
Rosemead, CA 91770-5204
Phone
(626) 307-1718
NPI assigned
Jun 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Nieves Bernardino Daclison, PTNPI 1124223813
Title
President
Phone
(626) 307-1718

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

2630 San Gabriel Blvd
Suite 104
Rosemead, CA 91770-5204

Mailing address

2630 San Gabriel Blvd
Suite 104
Rosemead, CA 91770-5204
Phone (626) 307-1718

Other names 1

  • Ultimate Rehabilitation Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

2630 San Gabriel Blvd
Ste 104
Rosemead, CA 91770
Phone (626) 307-1718

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1104023464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 SAN GABRIEL BLVD",
            "address_2": "SUITE 104",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917705204",
            "telephone_number": "626-307-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 SAN GABRIEL BLVD",
            "address_2": "SUITE 104",
            "city": "ROSEMEAD",
            "state": "CA",
            "postal_code": "917705204",
            "telephone_number": "626-307-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE PHYSICAL THERAPY AND REHABILITATION CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-29",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "DACLISON",
        "authorized_official_first_name": "NIEVES",
        "authorized_official_middle_name": "BERNARDINO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-307-1718",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ultimate Rehabilitation Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rosemead, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.