Individual provider Active NPI

Marissa Vasquez

  • Physical Therapist
  • Corona, CA
National Provider Identifier
1336979194
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
306498 Issued in CA
Practice address
255 E Rincon St Ste 112
Corona, CA 92879-1375
Phone
(951) 523-8509
NPI assigned
Aug 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 306498 CA Primary

Addresses

Primary practice location

255 E Rincon St Ste 112
Corona, CA 92879-1375

Mailing address

72 Summerstone
Irvine, CA 92614-7000
Phone (949) 751-9096

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903002165 CA Practitioner - Physical Therapist in Private Practice 5294274320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impt IncGroup PAC ID 9335112762, 20 clinicians

Practice addresses (Care Compare)

11420 Warner Ave
Suite B
Fountain Valley, CA 92708-2529
Phone (657) 204-2959

16561 Bolsa Chica St
Suite 100
Huntington Beach, CA 92649-3594
Phone (949) 861-8600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist CurrentSince Aug 13, 2024 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Current Accepting new patients
California Rehab & Sports Therapy CurrentSince Aug 13, 2024 Accepting new patients
Impt, Inc. Physical Therapist CurrentSince Feb 6, 2026 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Past Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Past Accepting new patients

Locations

505 N Euclid St
Ste 680
Anaheim, CA 92801
Phone (714) 780-0010

471 W Lambert Rd
Ste 106
Brea, CA 92821
Phone (714) 255-8877

415 Carmen Dr
Camarillo, CA 93010
Phone (805) 322-9083

255 E Rincon St
Ste 112
Corona, CA 92879
Phone (951) 523-8509

11420 Warner Ave
Ste B
Fountain Valley, CA 92708
Phone (657) 204-2959

16561 Bolsa Chica St
Ste 100
Huntington Beach, CA 92649
Phone (714) 364-1313

17332 Von Karman Ave
Ste 120
Irvine, CA 92614
Phone (949) 861-8600

2888 Long Beach Blvd
Ste 405
Long Beach, CA 90806
Phone (562) 595-4489

19000 Hawthorne Blvd
Ste 300
Torrance, CA 90503
Phone (310) 793-1800

2600 Dallas Pkwy
Ste 290
Frisco, TX 75034
Phone (945) 260-0010

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1336979194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 SUMMERSTONE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926147000",
            "telephone_number": "949-751-9096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E RINCON ST STE 112",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928791375",
            "telephone_number": "951-523-8509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "MARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "306498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.