Individual provider Active NPI

Brandon McMinn, PT, DPT

  • Physical Therapist
  • Stockton, CA
National Provider Identifier
1205694437
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT305506 Issued in CA
Practice address
1716 W Hammer LN
Stockton, CA 95209-2922
Phone
(209) 473-2383
Fax
(209) 473-1350
NPI assigned
Mar 12, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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 PT305506 CA Primary

Addresses

Primary practice location

1716 W Hammer LN
Stockton, CA 95209-2922

Mailing address

408 Higuera St Ste 200
San Luis Obispo, CA 93401-6135
Phone (805) 788-0805

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240327002186 CA Practitioner - Physical Therapist in Private Practice 0941647812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CV Physical Therapy, Inc.Group PAC ID 5698834174, 20 clinicians

Practice addresses (Care Compare)

1716 W Hammer LN
Stockton, CA 95209-2922
Phone (204) 473-2383

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT305506CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
CV Physical Therapy, Inc. Physical Therapist CurrentSince Mar 25, 2024 Accepting new patients

Locations

408 Higuera St
Ste 200
Sn Luis Obisp, CA 93401

1716 W Hammer Ln
Stockton, CA 95209
Phone (204) 473-2383

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1205694437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 HIGUERA ST STE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016135",
            "telephone_number": "805-788-0805",
            "fax_number": "805-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1716 W HAMMER LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952092922",
            "telephone_number": "209-473-2383",
            "fax_number": "209-473-1350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMINN",
        "first_name": "BRANDON",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT305506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.