Individual provider Active NPI

Soad A Salam, RPT BS PHYSICAL THER

  • Physical Therapist
  • Lakewood, CA
National Provider Identifier
1194898130
Registry record updated Oct 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT8778 Issued in CA
Practice address
5750 Downey Ave
Suite 301
Lakewood, CA 90712-1405
Phone
(562) 633-3501
Fax
(562) 421-1444
NPI assigned
Nov 16, 2006
Last updated
Oct 5, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2011

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 PT8778 CA Primary

Addresses

Primary practice location

5750 Downey Ave
Suite 301
Lakewood, CA 90712-1405

Mailing address

31961 Monarch CRST
Laguna Niguel, CA 92677-5451
Phone (714) 308-6171

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120809000808 CA Practitioner - Physical Therapist in Private Practice 1557517331 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science

State licenses

LicenseStateTypeSpecialty
8778CAMDAcupuncturist
PT8778CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
South Coast Physical Therapy Physical Therapist CurrentSince Jan 12, 2001 Accepting new patients

Locations

17752 Beach Blvd
#306
Huntington Beach, CA 92647
Phone (714) 842-6171

5220 Clark Ave
Ste 205
Lakewood, CA 90712
Phone (562) 421-1008

5750 Downey Ave
Ste 301
Lakewood, CA 90712
Phone (562) 633-3501

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1194898130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31961 MONARCH CRST",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926775451",
            "telephone_number": "714-308-6171",
            "fax_number": "949-234-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 DOWNEY AVE",
            "address_2": "SUITE 301",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121405",
            "telephone_number": "562-633-3501",
            "fax_number": "562-421-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALAM",
        "first_name": "SOAD",
        "middle_name": "A",
        "credential": "RPT BS PHYSICAL THER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT8778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.