NPIMap

Organization Active NPI

JRD Physical Therapy Inc

  • Physical Therapist
  • Los Alamitos, CA
National Provider Identifier
1255875431
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT12977 Issued in CA
Legal business name
JRD PHYSICAL THERAPY INC
Practice address
4220 Katella Avenue
Los Alamitos, CA 90720-4909
Phone
(562) 342-9994
NPI assigned
Dec 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Authorized official

Name
John Randolph Davies, PTNPI 1003036765
Title
President
Phone
(562) 355-1550

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 SINGLE SPECIALTY GROUP 225100000X PT12977 CA Primary

Addresses

Primary practice location

4220 Katella Avenue
Los Alamitos, CA 90720-4909

Mailing address

4220 Katella Avene.
Los Alamitos, CA 90720-4909
Phone (562) 342-9994

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170110001112 CA Part B Supplier - Clinic/Group Practice 9931480787 Receives reassigned benefits from 6 practitioners
Practice locations: Los Alamitos, CA

National Provider Directory

National Provider Directory

Locations

4220 Katella Ave
Los Alamitos, CA 90720
Phone (562) 342-9994

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1481068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1255875431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 KATELLA AVENE.",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907204909",
            "telephone_number": "562-342-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 KATELLA AVENUE",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907204909",
            "telephone_number": "562-342-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JRD PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-07",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "DAVIES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "RANDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-355-1550",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT12977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Alamitos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.