Individual provider Active NPI

Danica Noel Halverson, P.T.A.

  • Physical Therapy Assistant
  • Costa Mesa, CA
National Provider Identifier
1124203468
Registry record updated Jan 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
AT 8467 Issued in CA
Practice address
2951 Harbor Blvd
Costa Mesa, CA 92626-3912
Phone
(714) 546-7575
NPI assigned
Jan 6, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X AT 8467 CA Primary

Addresses

Primary practice location

2951 Harbor Blvd
Costa Mesa, CA 92626-3912

Mailing address

712 Meridian Ave
South Pasadena, CA 91030-2524
Phone (714) 390-8607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AT 8467CAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1199577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199577600000",
    "number": "1124203468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 MERIDIAN AVE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910302524",
            "telephone_number": "714-390-8607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2951 HARBOR BLVD",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263912",
            "telephone_number": "714-546-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVERSON",
        "first_name": "DANICA",
        "middle_name": "NOEL",
        "name_prefix": "Mrs.",
        "credential": "P.T.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-06",
        "last_updated": "2008-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "AT 8467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 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.