Active NPI
Lawrence Peralta Liwanag, PT
- Physical Therapist
- Vallejo, CA
National Provider Identifier
1285618140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT30202
- Practice address
- 127 Hospital Dr
Ste 101
Vallejo, CA 94589-2500 - Phone
- (707) 552-8795
- Fax
- (707) 552-9638
- NPI assigned
- Dec 5, 2005
- Sex
- Male
- 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 | PT30202 | CA | Primary |
Addresses
Primary practice location
127 Hospital Dr
Ste 101
Vallejo, CA 94589-2500
Mailing address
860 Southampton Rd
Benicia, CA 94510-1907
Phone (707) 745-6144
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPT302020 | Other | CA | MEDICARE PTAN |
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 |
|---|---|---|---|
| PT30202 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grove, Andersen, Ghiringhelli Physical Therapy a Professional Co | 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 and National Provider Directory roles.
-
- Physical Therapist
- Benicia, CA
- NPI 1558343038
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429833600000",
"number": "1285618140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 SOUTHAMPTON RD",
"city": "BENICIA",
"state": "CA",
"postal_code": "945101907",
"telephone_number": "707-745-6144",
"fax_number": "707-745-5698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 HOSPITAL DR",
"address_2": "STE 101",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892500",
"telephone_number": "707-552-8795",
"fax_number": "707-552-9638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIWANAG",
"first_name": "LAWRENCE",
"middle_name": "PERALTA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-05",
"last_updated": "2015-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT30202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "OPT302020",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.