Individual provider Active NPI

Ian Segalla, PT, DPT

  • Physical Therapist
  • La Mesa, CA
National Provider Identifier
1124981964
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
306193 Issued in CA
Practice address
5565 Grossmont Center Dr Ste 360
La Mesa, CA 91942-3087
Phone
(619) 315-0035
NPI assigned
Dec 8, 2025
Last updated
Mar 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 306193 CA Primary

Addresses

Primary practice location

5565 Grossmont Center Dr Ste 360
La Mesa, CA 91942-3087

Mailing address

2020 El Cajon Blvd Apt 608
San Diego, CA 92104-3882
Phone (860) 806-3937

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260309002811 CA Practitioner - Physical Therapist in Private Practice 2062995020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Northeastern Ohio University College of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
G O M G a Medical PartnershipGroup PAC ID 1153427836, 13 clinicians

Practice addresses (Care Compare)

5565 Grossmont Ctr Dr
Suite 256
La Mesa, CA 91942-3098
Phone 6194623131232

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
306193CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
G O M G a Medical Partnership CurrentSince Feb 9, 2026 Accepting new patients

Locations

5565 Grossmont Center Dr
Ste 256
La Mesa, CA 91942
Phone (619) 421-3400

5565 Grossmont Center Dr
Ste 360
La Mesa, CA 91942
Phone (619) 315-0035

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1765152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1124981964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 EL CAJON BLVD APT 608",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921043882",
            "telephone_number": "860-806-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR STE 360",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423087",
            "telephone_number": "619-315-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGALLA",
        "first_name": "IAN",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-08",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "306193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.