NPIMap

Organization Active NPI

Wimbledon Park Physical Therapy

  • Physical Therapist
  • Victorville, CA
National Provider Identifier
1366484131
Registry record updated Aug 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13643 Issued in CA
Legal business name
WIMBLEDON PARK PHYSICAL THERAPY
Practice address
12611 Hesperia Rd
Ste B
Victorville, CA 92395-7720
Phone
(760) 951-9702
Fax
(760) 951-8594
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2007

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

Authorized official

Name
Mr. Jerry Hopper, PT
Title
Manager
Phone
(760) 951-9702

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT13643 CA Primary

Addresses

Primary practice location

12611 Hesperia Rd
Ste B
Victorville, CA 92395-7720

Mailing address

12611 Hesperia Rd
Ste B
Victorville, CA 92395-7720
Phone (760) 951-9702

National Provider Directory

National Provider Directory

Locations

12611 Hesperia Rd
Ste B
Victorville, CA 92395
Phone (760) 951-9702

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186963200000",
    "number": "1366484131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12611 HESPERIA RD",
            "address_2": "STE B",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957720",
            "telephone_number": "760-951-9702",
            "fax_number": "760-951-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 HESPERIA RD",
            "address_2": "STE B",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957720",
            "telephone_number": "760-951-9702",
            "fax_number": "760-951-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIMBLEDON PARK PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2007-08-13",
        "status": "A",
        "authorized_official_last_name": "HOPPER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "760-951-9702",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT13643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2007; 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.