Active NPI
Priscilla Philips Walters, PT
- Physical Therapist
- Rancho Cucamonga, CA
National Provider Identifier
1245338508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5398
- Practice address
- 10470 Foothill Blvd Ste 101
Rancho Cucamonga, CA 91730-3754 - Phone
- (909) 948-0411
- Fax
- (909) 948-0511
- NPI assigned
- Sep 20, 2006
- Last updated
- Jun 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5398 | CA | Primary |
Addresses
Primary practice location
10470 Foothill Blvd Ste 101
Rancho Cucamonga, CA 91730-3754
Mailing address
1845 Business Center Dr
Suite 127
San Bernardino, CA 92408-3467
Phone (909) 890-9030
Other practice location 1
1902 Royalty Dr Ste 220
Pomona, CA 91767-3056
Phone (909) 622-0006
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245338508 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5398 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Therapy Network Inc | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Glendora, CA
- NPI 1750500161
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560384000000",
"number": "1245338508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1845 BUSINESS CENTER DR",
"address_2": "SUITE 127",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083467",
"telephone_number": "909-890-9030",
"fax_number": "909-890-4393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10470 FOOTHILL BLVD STE 101",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917303754",
"telephone_number": "909-948-0411",
"fax_number": "909-948-0511"
}
],
"practiceLocations": [
{
"address_1": "1902 Royalty Dr Ste 220",
"address_purpose": "LOCATION",
"city": "Pomona",
"state": "CA",
"postal_code": "917673056",
"country_code": "US",
"telephone_number": "909-622-0006",
"fax_number": "909-622-0007",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALTERS",
"first_name": "PRISCILLA",
"middle_name": "PHILIPS",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2019-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "5398",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245338508",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.