Individual provider Active NPI

Harold Nelson, P.T.

  • Physical Therapist
  • Garden Grove, CA
National Provider Identifier
1164479739
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT7788 Issued in CA
Practice address
12572 Valley View St
Attention Jody Lane
Garden Grove, CA 92845-2006
Phone
(714) 823-4400
Fax
(714) 823-4404
NPI assigned
May 28, 2006
Last updated
Mar 30, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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 PT7788 CA Primary

Addresses

Primary practice location

12572 Valley View St
Attention Jody Lane
Garden Grove, CA 92845-2006

Mailing address

12572 Valley View St
Attention Jody Lane
Garden Grove, CA 92845-2006
Phone (714) 823-4400

Other identifiers 1

IdentifierTypeStateIssuer
PT7788OtherCAPT LICENSE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT7788CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Naf Physical Therapy Inc Physical Therapist PastSince Jan 4, 2010 Accepting new patients
Caremore Medical Group Inc Past Accepting new patients
Nifty After Fifty Physical Therapist Past Accepting new patients
Caremore Medical Group Past Accepting new patients

Organizations & group practices 4

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": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1164479739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12572 VALLEY VIEW ST",
            "address_2": "ATTENTION JODY LANE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928452006",
            "telephone_number": "714-823-4400",
            "fax_number": "714-823-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12572 VALLEY VIEW ST",
            "address_2": "ATTENTION JODY LANE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928452006",
            "telephone_number": "714-823-4400",
            "fax_number": "714-823-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "HAROLD",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT7788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT7788",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; 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.