NPIMap

Organization Active NPI

Marina Sports Physical Therapy P C

  • Physical Therapist
  • Rancho Palos Verdes, CA
National Provider Identifier
1225522725
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MARINA SPORTS PHYSICAL THERAPY P C
Practice address
28382 S Western Ave
Rancho Palos Verdes, CA 90275-1434
Phone
(310) 526-8599
NPI assigned
Jun 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Authorized official

Name
Nicole C Vittorio, PTNPI 1164824629
Title
President
Phone
(310) 526-8599

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

28382 S Western Ave
Rancho Palos Verdes, CA 90275-1434

Mailing address

28633 S Western Ave Ste 200
Rancho Palos Verdes, CA 90275-0817
Phone (310) 832-2622

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180820003713 CA Part B Supplier - Clinic/Group Practice 0143579458 Receives reassigned benefits from 6 practitioners
Practice locations: Rancho Palos Verdes, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1225522725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28633 S WESTERN AVE STE 200",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902750817",
            "telephone_number": "310-832-2622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28382 S WESTERN AVE",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902751434",
            "telephone_number": "310-526-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARINA SPORTS PHYSICAL THERAPY P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "VITTORIO",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-526-8599",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Palos Verdes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; 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.