Biosport Physical Therapy Inc
Organization Active NPI Physical Therapy Clinic/Center · Modesto, CA
NPI 1104127554 · NPPES record last updated Mar 31, 2022
Key facts
- NPI
- 1104127554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 27941 (CA)
- Legal business name
- BIOSPORT PHYSICAL THERAPY INC
- Practice address
- 4341 Spyres Way
Modesto, CA 95356-9259 - Phone
- (209) 524-7488
- Fax
- (209) 522-7488
- NPI assigned
- Nov 16, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Leovardo Chavez, MPT, DPT, ATC
- Title
- Physical Therapist / President
- Phone
- (209) 524-7488
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 15
-
Brittanie Rachelle Brantley, PT, DPT
-
Sean Fjellstrom, DPT
-
Tim Fernandes, DPT
-
Kevin Marquez, DPT
-
Gilberto Aranda, DPT
-
Omar Renato Flores, DPT
-
Franchesca Suazo, DPT
-
Julie Deen Tanaka, P.T.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111004000411 | CA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6709058332 |
Receives reassigned benefits from 10 practitioners 1 other NPI on this enrollment Practice locations: Manteca, CA; Modesto, CA |
National Provider Directory
- Tax ID family
- Biosport Physical Therapy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 27941 | CA | Yes |
Addresses
Primary practice location
4341 Spyres Way
Modesto, CA 95356-9259
Mailing address
PO Box 576751
Modesto, CA 95357-6751
Phone (209) 524-7488
Other providers in Modesto, CA
- Big Valley Midwives
- Bineshwar Ben Prasad
- Curtis Ryan Bingham
- Jeffrey Call Bingham
- Sydney Binns
- Beverly Jane Bird
- Catherine A Biren
- Inderjit Birring
- Satinder K Birring
- Julie Kathryn Birt
All providers in Modesto, CA · Physical Therapy Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.