Individual provider Active NPI

Collen Edward Wooten, PT, DPT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1356852495
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
293640 Issued in CA
Practice address
3200 4TH Ave
San Diego, CA 92103-5716
Phone
(260) 414-2109
NPI assigned
Oct 17, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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 293640 CA Primary

Addresses

Primary practice location

3200 4TH Ave
San Diego, CA 92103-5716

Mailing address

3220 Tyler St
Carlsbad, CA 92008-3053
Phone (260) 414-2109

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180111002988 CA Practitioner - Physical Therapist in Private Practice 4082973375 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MDRS Spine and Sport IncGroup PAC ID 3274446687, 181 clinicians

Practice addresses (Care Compare)

2240 E Plaza Blvd
Suite B E
National City, CA 91950-5164
Phone (619) 745-5932

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Nexus Physical Therapy Physical Therapist CurrentSince Oct 12, 2017 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Dec 15, 2024 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Dec 15, 2024 Accepting new patients

Locations

450 Rosewood Ave
Ste 105
Camarillo, CA 93010
Phone (805) 389-4781

1020 Tierra del Rey
Ste A1
Chula Vista, CA 91910
Phone (619) 585-7104

14150 Culver Dr
Ste 103
Irvine, CA 92604
Phone (949) 262-9142

2240 E Plaza Blvd
Ste Be
National City, CA 91950
Phone (619) 474-5916

9852 Business Park Dr
Ste A
Sacramento, CA 95827
Phone (916) 362-7962

3200 4th Ave
Ste 100
San Diego, CA 92103
Phone (619) 293-3994

780 Dennery Rd
Ste 301
San Diego, CA 92154
Phone (619) 859-4501

1801 Cleveland Ave
Ste B
Santa Rosa, CA 95401
Phone (707) 526-4180

5850 Canoga Ave
Ste 120
Woodland Hills, CA 91367
Phone (747) 255-4089

Organizations & group practices 3

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": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1356852495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 TYLER ST",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920083053",
            "telephone_number": "260-414-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035716",
            "telephone_number": "260-414-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTEN",
        "first_name": "COLLEN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "293640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; 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.