Individual provider Active NPI

Colleen Hurd Sanders, PT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1174933063
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT23090 Issued in CA
Practice address
4146 Tamilynn CT
San Diego, CA 92122-3428
Phone
(858) 442-0089
Fax
(858) 450-0363
NPI assigned
May 1, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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 PT23090 CA Primary

Addresses

Primary practice location

4146 Tamilynn CT
San Diego, CA 92122-3428

Mailing address

4146 Tamilynn CT
San Diego, CA 92122-3428
Phone (858) 442-0089

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141024002198 CA Practitioner - Physical Therapist in Private Practice 1557582004 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Manual Orthopedic Physical Therapy IncGroup PAC ID 4880688910, 20 clinicians

Practice addresses (Care Compare)

955 Lane Ave
Suite 201
Chula Vista, CA 91914-4525
Phone (619) 421-9521

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23090CAMDClinical Social Worker
PT23090CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Manual Orthopedic Physical Therapy Inc Physical Therapist CurrentSince Apr 15, 2014 Accepting new patients
Manual Orthopedic Physical Therapy, Inc. Physical Therapist CurrentSince Apr 15, 2014 Accepting new patients

Locations

885 Canarios Ct
Ste 110
Chula Vista, CA 91910
Phone (619) 349-0797

955 Lane Ave
Ste 201
Chula Vista, CA 91914
Phone (619) 421-9521

Organizations & group practices 2

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": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1174933063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4146 TAMILYNN CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921223428",
            "telephone_number": "858-442-0089",
            "fax_number": "858-450-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4146 TAMILYNN CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921223428",
            "telephone_number": "858-442-0089",
            "fax_number": "858-450-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "COLLEEN",
        "middle_name": "HURD",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-01",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT23090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; 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.