Individual provider Active NPI

Lianna M. Roberts, PT

  • Orthopedic Physical Therapist
  • Los Gatos, CA
National Provider Identifier
1174852057
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
35099 Issued in CA
Practice address
16615 Lark Ave
Suite #101
Los Gatos, CA 95032-7645
Phone
(408) 358-1460
Fax
(408) 358-1459
NPI assigned
Dec 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 35099 CA
Orthopedic Physical Therapist 2251X0800X 35099 CA Primary

Addresses

Primary practice location

16615 Lark Ave
Suite #101
Los Gatos, CA 95032-7645

Mailing address

16615 Lark Ave
Suite #101
Los Gatos, CA 95032-7645
Phone (408) 358-1460

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110127000321 CA Practitioner - Physical Therapist in Private Practice 3577742279 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
May accept Medicare assignment
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians
Los Gatos Orthopedic Sports Therapy, Inc.Group PAC ID 1153417951, 8 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

16615 Lark Ave
Los Gatos, CA 95032-7645
Phone (408) 358-1460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Los Gatos Orthopedic Sports Therapy, Inc. Pediatrics CurrentSince Oct 24, 2010 Accepting new patients
Los Gatos Hand Therapy, LLC PastSince Jun 6, 2021 Accepting new patients

Locations

16615 Lark Ave
Ste 101
Los Gatos, CA 95032
Phone (408) 358-1460

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1261526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1174852057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16615 LARK AVE",
            "address_2": "SUITE #101",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950327645",
            "telephone_number": "408-358-1460",
            "fax_number": "408-358-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16615 LARK AVE",
            "address_2": "SUITE #101",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950327645",
            "telephone_number": "408-358-1460",
            "fax_number": "408-358-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "LIANNA",
        "middle_name": "M.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-23",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "35099",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "35099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2021; 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.