Individual provider Active NPI

Thomas Hombo, ATC, PTA

  • Physical Therapy Assistant
  • San Dimas, CA
National Provider Identifier
1396320867
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
51094 Issued in CA
Practice address
1043 N Walnut Ave
San Dimas, CA 91773-1521
Phone
(909) 599-7002
NPI assigned
Mar 16, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225200000X 51094 CA Primary

Addresses

Primary practice location

1043 N Walnut Ave
San Dimas, CA 91773-1521

Mailing address

1043 N Walnut Ave
San Dimas, CA 91773-1521
Phone (909) 599-7002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
51094CAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1396320867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 N WALNUT AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731521",
            "telephone_number": "909-599-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 N WALNUT AVE",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917731521",
            "telephone_number": "909-599-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOMBO",
        "first_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "ATC, PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "51094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Dimas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.