NPIMap

Organization Active NPI

Ignite Phyzio & Sports Performance Inc

  • Physical Therapy Clinic/Center
  • La Habra, CA
National Provider Identifier
1306354881
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT37147 Issued in CA
Legal business name
IGNITE PHYZIO & SPORTS PERFORMANCE INC
Practice address
811 E Lambert Rd
La Habra, CA 90631-6143
Phone
(562) 896-0129
NPI assigned
Jan 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

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

Authorized official

Name
Ziad Dahdul, PTNPI 1467761395
Title
Owner
Phone
(562) 896-0129

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 Therapy Clinic/Center 261QP2000X PT37147 CA Primary

Addresses

Primary practice location

811 E Lambert Rd
La Habra, CA 90631-6143

Mailing address

1703 Shady Brook Dr
Fullerton, CA 92831-1850
Phone (562) 896-0129

Other practice location 1

1703 Shady Brook Dr
Fullerton, CA 92831-1850
Phone (562) 896-0129

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200403000317 CA Part B Supplier - Clinic/Group Practice 0042649584 Receives reassigned benefits from 10 practitioners
Practice locations: La Habra, CA; Costa Mesa, CA

National Provider Directory

National Provider Directory
Tax ID family
Ignite Phyzio Sports Performance Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2925 Airway Ave
Ste A
Costa Mesa, CA 92626
Phone (714) 335-3182

811 E Lambert Rd
La Habra, CA 90631
Phone (562) 896-0129

2121 E Lambert Rd
Ste 306
La Habra, CA 90631

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583712000000",
    "number": "1306354881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 SHADY BROOK DR",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928311850",
            "telephone_number": "562-896-0129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 E LAMBERT RD",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906316143",
            "telephone_number": "562-896-0129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1703 Shady Brook Dr",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928311850",
            "country_code": "US",
            "telephone_number": "562-896-0129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IGNITE PHYZIO & SPORTS PERFORMANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A",
        "authorized_official_last_name": "DAHDUL",
        "authorized_official_first_name": "ZIAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-896-0129",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT37147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Habra, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.