NPIMap

Organization Active NPI

Pomona Valley Orthopedic and Sports Physical Therapy, Inc

Doing business as Gary M. Souza, PT & Associates

  • Physical Therapist
  • Diamond Bar, CA
National Provider Identifier
1255301461
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT10462 Issued in CA
Legal business name
POMONA VALLEY ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, INC
Doing business as
Gary M. Souza, PT & Associates
Practice address
21015 Pathfinder Rd
Suite 100
Diamond Bar, CA 91765-4018
Phone
(909) 861-3511
Fax
(909) 860-7900
NPI assigned
Jan 23, 2006
Last updated
Aug 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Authorized official

Name
Dr. Gary Souza, DPT, OCSNPI 1043315765
Title
Owner,President
Phone
(909) 861-3511

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 Therapist 225100000X PT10462 CA Primary

Addresses

Primary practice location

21015 Pathfinder Rd
Suite 100
Diamond Bar, CA 91765-4018

Mailing address

21015 Pathfinder Rd
Suite 100
Diamond Bar, CA 91765-4018
Phone (909) 861-3511

Other identifiers 1

IdentifierTypeStateIssuer
DC9491OtherCARAILROAD MEDICARE GROUP #

Other names 1

  • Gary M. Souza, PT & Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090512000140 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4284536814 Receives reassigned benefits from 20 practitioners
Practice locations: Diamond Bar, CA
O20190805001398 CA DME Supplier - Independently-Practicing Physical Therapist 4284536814 Practice locations: Diamond Bar, CA

National Provider Directory

National Provider Directory

Locations

1400 Montefino Ave
Ste 110
Diamond Bar, CA 91765
Phone (909) 861-3511

21015 Pathfinder Rd
Ste 100
Diamond Bar, CA 91765
Phone (909) 861-3511

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596758400000",
    "number": "1255301461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21015 PATHFINDER RD",
            "address_2": "SUITE 100",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654018",
            "telephone_number": "909-861-3511",
            "fax_number": "909-860-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21015 PATHFINDER RD",
            "address_2": "SUITE 100",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917654018",
            "telephone_number": "909-861-3511",
            "fax_number": "909-860-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMONA VALLEY ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "SOUZA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER,PRESIDENT",
        "authorized_official_telephone_number": "909-861-3511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT10462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "DC9491",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gary M. Souza, PT & Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Diamond Bar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2020; 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.