Active NPI
Audra Ponci Bado, M.P.T.
- Hand Physical Therapist
- Los Angeles, CA
National Provider Identifier
1164627436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Physical Therapist
- License
- 26768
- Practice address
- 12099 W Washington Blvd Ste 300
Los Angeles, CA 90066-2621 - Phone
- (213) 935-8566
- Fax
- (310) 535-0009
- NPI assigned
- Jun 18, 2007
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 26768 | CA | |
| Hand Physical Therapist | 2251H1200X | |||
| Hand Physical Therapist | 2251H1200X | 26768 | CA | Primary |
Addresses
Primary practice location
12099 W Washington Blvd Ste 300
Los Angeles, CA 90066-2621
Mailing address
12099 W. Washington Blvd
Ste 300
Culver Cite, CA 90066
Phone (213) 935-8566
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
| License | State | Type | Specialty |
|---|---|---|---|
| 26768 | CA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Body Awareness Physical Therapy, Inc | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Costa Mesa, CA
- NPI 1164439915
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1164627436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12099 W. WASHINGTON BLVD",
"address_2": "STE 300",
"city": "CULVER CITE",
"state": "CA",
"postal_code": "90066",
"telephone_number": "213-935-8566",
"fax_number": "310-535-0009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12099 W WASHINGTON BLVD STE 300",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900662621",
"telephone_number": "213-935-8566",
"fax_number": "310-535-0009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BADO",
"first_name": "AUDRA",
"middle_name": "PONCI",
"credential": "M.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-18",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "26768",
"primary": false
},
{
"code": "2251H1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Hand",
"state": null,
"license": null,
"primary": false
},
{
"code": "2251H1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Hand",
"state": "CA",
"license": "26768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.