Proactive Physical Therapy & Sports Medicine

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE

Practice address

10806 Willow CT
San Diego, CA 92127-2428

Phone

(858) 381-5084

NPI assigned

Jun 11, 2008

Organization subpart

No

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

Authorized official

Name

Jack Pentlarge

Title

Owner

Phone

(760) 444-0102

Specialties & licenses 1

Addresses

Tax ID family

Proactiv Physical Therapy Sports Medicine2 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.

• Proactive Physical Therapy & Sports Medicine Inc

  • Physical Therapy Clinic/Center
  • Carlsbad, CA
  • NPI 1285729509
  NPD tax ID

Locations

Practitioners 1

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

• Amyn Valji, OPT

  • Occupational Therapist
  • Carlsbad, CA
  • NPI 1225123532
  NPD

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1316107410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6070 AVENIDA ENCINAS",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111001",
            "telephone_number": "760-444-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10806 WILLOW CT",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921272428",
            "telephone_number": "858-381-5084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "PENTLARGE",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-444-0102"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Private Healthcare Facilities
• David Michael Priver, MD
• Pro to Col Sport Systems
• Natasha Proa
• Proactive Care Pharmacy, LLC.
• Procare Home Health Services Inc
• Procare Pharmacy LLC
• Ann Marie T. Prochera, M.D.
• Andrea Lynn Procko, MS, PHD
• Bradley Wayne Proctor, IDC

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.