NPIMap

Organization Active NPI

Prosport Physical Therapy Professionals Inc

  • Physical Therapist
  • Laguna Hills, CA
National Provider Identifier
1346619210
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROSPORT PHYSICAL THERAPY PROFESSIONALS INC
Practice address
23001 Del Lago Dr
Suite C-1
Laguna Hills, CA 92653-1354
Phone
(949) 387-7333
Fax
(949) 916-7309
NPI assigned
Sep 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Bobby Ismail
Title
President
Phone
(209) 353-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

23001 Del Lago Dr
Suite C-1
Laguna Hills, CA 92653-1354

Mailing address

PO Box 14155
Orange, CA 92863-1555
Phone (714) 450-4999

Other names 1

  • ProSport Physical Therapy-Laguna Hills, Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200304001273 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749510634 Receives reassigned benefits from 107 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orange, CA; Torrance, CA; San Juan Capistrano, CA; San Clemente, CA; Rancho Santa Margarita, CA; Rancho Palos Verdes, CA; Mission Viejo, CA; Los Angeles, CA…

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Prosport Physical Therapy Professionals Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1346619210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14155",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928631555",
            "telephone_number": "714-450-4999",
            "fax_number": "714-974-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23001 DEL LAGO DR",
            "address_2": "SUITE C-1",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531354",
            "telephone_number": "949-387-7333",
            "fax_number": "949-916-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPORT PHYSICAL THERAPY PROFESSIONALS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-353-1988"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProSport Physical Therapy-Laguna Hills, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.