NPIMap

Organization Active NPI

Biosport Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Modesto, CA
National Provider Identifier
1104127554
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
27941 Issued in 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
Last updated
Mar 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Dr. Leovardo Chavez, MPT, DPT, ATCNPI 1972668598
Title
Physical Therapist / President
Phone
(209) 524-7488

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 27941 CA Primary

Addresses

Primary practice location

4341 Spyres Way
Modesto, CA 95356-9259

Mailing address

PO Box 576751
Modesto, CA 95357-6751
Phone (209) 524-7488

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Biosport Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

18800 Main St
Ste A
Groveland, CA 95321
Phone (209) 524-7488

1325 Historical Plaza Way
Manteca, CA 95336
Phone (209) 524-7488

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1104127554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 576751",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953576751",
            "telephone_number": "209-524-7488",
            "fax_number": "209-522-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4341 SPYRES WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569259",
            "telephone_number": "209-524-7488",
            "fax_number": "209-522-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIOSPORT PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "LEOVARDO",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST / PRESIDENT",
        "authorized_official_telephone_number": "209-524-7488",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MPT,  DPT, ATC"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "27941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.