Premier Physical Therapy and Wellness Clinic Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT26104 Issued in CA

Legal business name

PREMIER PHYSICAL THERAPY AND WELLNESS CLINIC INC.

Practice address

1300 W 6TH St
Suite 3
San Pedro, CA 90732-3531

Phone

(310) 217-9088

NPI assigned

Mar 11, 2013

Last updated

Mar 6, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Anthony Berkovich, PTNPI 1407073133

Title

Owner

Phone

(310) 519-1030

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Anthony Berkovich Sr., PT

  • Physical Therapist
  • Rancho Palos Verdes, CA
  • NPI 1407073133
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1362960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520294400000",
    "number": "1225379597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 W 6TH ST STE 3",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323531",
            "telephone_number": "310-519-1030",
            "fax_number": "310-519-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W 6TH ST",
            "address_2": "SUITE 3",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323531",
            "telephone_number": "310-217-9088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY AND WELLNESS CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-11",
        "last_updated": "2018-03-06",
        "status": "A",
        "authorized_official_last_name": "BERKOVICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-519-1030",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT26104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "DL193A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2018; 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.