NPIMap

Organization Active NPI

Harbor Physical Therapy & Sports Medical

  • Orthopedic Physical Therapist
  • San Pedro, CA
National Provider Identifier
1255349676
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT11977 Issued in CA
Legal business name
HARBOR PHYSICAL THERAPY & SPORTS MEDICAL
Practice address
1294 West 6TH Street
Suite 101
San Pedro, CA 90732-2997
Phone
(310) 547-1850
Fax
(310) 547-1972
NPI assigned
Aug 3, 2006
Last updated
Nov 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Authorized official

Name
Mr. Michael T Odonnell, DPT, OCSNPI 1275541724
Title
Owner/Director
Phone
(310) 547-1850

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
Orthopedic Physical Therapist 2251X0800X PT11977 CA Primary

Addresses

Primary practice location

1294 West 6TH Street
Suite 101
San Pedro, CA 90732-2997

Mailing address

1294 West 6TH Street
Suite 101
San Pedro, CA 90732-2997
Phone (310) 547-1850

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000683 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4880861103 Receives reassigned benefits from 15 practitioners
Practice locations: San Pedro, CA

National Provider Directory

National Provider Directory

Locations

1294 W 6th St
Ste 101
San Pedro, CA 90731
Phone (310) 547-1850

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1255349676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 WEST 6TH STREET",
            "address_2": "SUITE 101",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322997",
            "telephone_number": "310-547-1850",
            "fax_number": "310-547-1972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1294 WEST 6TH STREET",
            "address_2": "SUITE 101",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907322997",
            "telephone_number": "310-547-1850",
            "fax_number": "310-547-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR PHYSICAL THERAPY & SPORTS MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "ODONNELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "310-547-1850",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT11977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.