Organization Active NPI

Finishline Physical Therapy Inc.

  • Physical Therapy Clinic/Center
  • Vista, CA
National Provider Identifier
1104816057
Registry record updated Mar 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT22017 Issued in CA
Legal business name
FINISHLINE PHYSICAL THERAPY INC.
Practice address
969 S Santa Fe Ave Ste E2
Vista, CA 92083-6910
Phone
(760) 330-9995
NPI assigned
Oct 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2019

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

Authorized official

Name
Mr. Gary Raymond, P.T
Title
Physician
Phone
(323) 465-9180

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT22017 CA Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

969 S Santa Fe Ave Ste E2
Vista, CA 92083-6910

Mailing address

969 S Santa Fe Ave Ste E2
Vista, CA 92083-6910
Phone (760) 330-9995

Other identifiers 1

IdentifierTypeStateIssuer
1104816057OtherCAAWAITING PROCESSING

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718000547 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4587691985 Receives reassigned benefits from 1 practitioner
Practice locations: Vista, CA

National Provider Directory

National Provider Directory

Locations

419 N Larchmont Blvd
#34
Los Angeles, CA 90004
Phone (323) 465-9180

531 N Larchmont Blvd
Ste 2
Los Angeles, CA 90004
Phone (323) 465-9180

969 S Santa Fe Ave
Ste E2
Vista, CA 92083
Phone (760) 330-9995

Practitioners & affiliated clinicians

Practitioners 1

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": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551916800000",
    "number": "1104816057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 S SANTA FE AVE STE E2",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836910",
            "telephone_number": "760-330-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 S SANTA FE AVE STE E2",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836910",
            "telephone_number": "760-330-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FINISHLINE PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-24",
        "last_updated": "2019-03-07",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "323-465-9180",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT22017",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AWAITING PROCESSING",
            "identifier": "1104816057",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; 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.