Taylor Kondo Henderson, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

298700 Issued in CA

Practice address

25255 Cabot Rd Ste 112
Laguna Hills, CA 92653-5507

Phone

(949) 229-0170

NPI assigned

Aug 11, 2020

Last updated

Apr 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Taylor Kondo Ellis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bloomwell Pediatric Wellness and Physical Therapy Inc

  • Pediatric Physical Therapist
  • Laguna Hills, CA
  • NPI 1093416273
  NPD Authorized official

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1356952576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CARIBOU CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928818424",
            "telephone_number": "951-314-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25255 CABOT RD STE 112",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535507",
            "telephone_number": "949-229-0170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "92 Argonaut Ste 170",
            "address_purpose": "LOCATION",
            "city": "Aliso Viejo",
            "state": "CA",
            "postal_code": "926564130",
            "country_code": "US",
            "telephone_number": "949-916-1654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "TAYLOR",
        "middle_name": "KONDO",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "298700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "ELLIS",
            "middle_name": "KONDO",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• A. Stephen Heller, DMD
• Helping Hand Care Management Corp
• Elyce Bloom Hemingway, M.A. CCC
• Namiyo Hemphill, LE. CPE
• Marsha T Henderson, LCSW
• Hendon Home LLC
• Timothy Hennessey
• Heidi Henri, C.O.T.A
• Andrew Henrick, M.D.
• Henry Cheng MD Inc

• Physical Therapist in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.

Verify at the official NPI Registry.