NPIMap

Organization Active NPI

Divine Health Provider Physical Therapy Inc

Doing business as Simi Physical Therapy Center

  • Physical Therapy Clinic/Center
  • Simi Valley, CA
National Provider Identifier
1386899763
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT24912 Issued in CA
Legal business name
DIVINE HEALTH PROVIDER PHYSICAL THERAPY INC
Doing business as
Simi Physical Therapy Center
Practice address
1687 Erringer Rd Ste 109
Simi Valley, CA 93065-6509
Phone
(805) 581-4266
Fax
(805) 581-5049
NPI assigned
Nov 26, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Jonah Tan, MPT, PA-CNPI 1477569010
Title
Director
Phone
(805) 581-4266

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT24912 CA Primary

Addresses

Primary practice location

1687 Erringer Rd Ste 109
Simi Valley, CA 93065-6509

Mailing address

1687 Erringer Rd Ste 109
Simi Valley, CA 93065-6509
Phone (805) 581-4266

Other practice location 1

3200 E Los Angeles Ave
Suite 20
Simi Valley, CA 93065-3971
Phone (805) 581-4266

Other names 1

  • Simi Physical Therapy Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090127000680 CA Part B Supplier - Clinic/Group Practice 6103980651 Receives reassigned benefits from 1 practitioner
Practice locations: Simi Valley, CA

National Provider Directory

National Provider Directory

Locations

1687 Erringer Rd
Ste 109
Simi Valley, CA 93065
Phone (805) 581-4266

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1227657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386899763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1687 ERRINGER RD STE 109",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930656509",
            "telephone_number": "805-581-4266",
            "fax_number": "805-581-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1687 ERRINGER RD STE 109",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930656509",
            "telephone_number": "805-581-4266",
            "fax_number": "805-581-5049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 E Los Angeles Ave",
            "address_2": "Suite 20",
            "address_purpose": "LOCATION",
            "city": "Simi Valley",
            "state": "CA",
            "postal_code": "930653971",
            "country_code": "US",
            "telephone_number": "805-581-4266",
            "fax_number": "805-581-5049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIVINE HEALTH PROVIDER PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TAN",
        "authorized_official_first_name": "JONAH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "805-581-4266",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT24912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simi Physical Therapy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.