Active NPI
Brad Diaz, PTA
- Physical Therapy Assistant
- Redding, CA
National Provider Identifier
1346088515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 9653
- Practice address
- 15200 La Paloma Way
Redding, CA 96001-9525 - Phone
- (530) 440-2047
- NPI assigned
- Jul 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 9653 | CA | Primary |
Addresses
Primary practice location
15200 La Paloma Way
Redding, CA 96001-9525
Mailing address
15200 La Paloma Way
Redding, CA 96001-9525
Phone (530) 440-2047
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9653 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721347200000",
"number": "1346088515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15200 LA PALOMA WAY",
"city": "REDDING",
"state": "CA",
"postal_code": "960019525",
"telephone_number": "530-440-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15200 LA PALOMA WAY",
"city": "REDDING",
"state": "CA",
"postal_code": "960019525",
"telephone_number": "530-440-2047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "BRAD",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-19",
"last_updated": "2024-07-19",
"certification_date": "2024-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "9653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.