NPIMap

Organization Active NPI

Evergreen Physical Therapy Specialists, Inc

  • Physical Therapy Clinic/Center
  • Pasadena, CA
National Provider Identifier
1346300670
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT18149 Issued in CA
Legal business name
EVERGREEN PHYSICAL THERAPY SPECIALISTS, INC
Practice address
111 S Hudson Ave
Pasadena, CA 91101-2606
Phone
(626) 683-8536
Fax
(626) 683-8236
NPI assigned
Dec 8, 2006
Last updated
Feb 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Authorized official

Name
Tabitha Wang
Title
Director of Resource Management
Phone
(626) 683-8536

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT18149 CA Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

111 S Hudson Ave
Pasadena, CA 91101-2606

Mailing address

PO Box 50004
Pasadena, CA 91115-0004
Phone (626) 683-8536

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050216000414 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9537111745 Receives reassigned benefits from 23 practitioners
Practice locations: Pasadena, CA

National Provider Directory

National Provider Directory

Locations

111 S Hudson Ave
Pasadena, CA 91101
Phone (626) 683-8536

200 E Del Mar Blvd
Ste 302
Pasadena, CA 91105
Phone (626) 683-8236

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675296000000",
    "number": "1346300670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50004",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911150004",
            "telephone_number": "626-683-8536",
            "fax_number": "626-683-8236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S HUDSON AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911012606",
            "telephone_number": "626-683-8536",
            "fax_number": "626-683-8236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHYSICAL THERAPY SPECIALISTS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_title_or_position": "DIRECTOR OF RESOURCE MANAGEMENT",
        "authorized_official_telephone_number": "626-683-8536"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT18149",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2023; 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.