Individual provider Active NPI

Brett Ballesteros

  • Physical Therapist
  • La Canada, CA
National Provider Identifier
1396370177
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
4515 Ocean View Blvd Ste 350
La Canada, CA 91011-1409
Phone
(818) 369-7620
NPI assigned
Mar 11, 2020
Last updated
Mar 11, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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 Primary

Addresses

Primary practice location

4515 Ocean View Blvd Ste 350
La Canada, CA 91011-1409

Mailing address

19217 Cantara St
Reseda, CA 91335-1115

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Function for Life Physical Therapy, Inc. Single Specialty CurrentSince Sep 20, 2021 Accepting new patients
Aaron McGuinness Physical Therapist Inc Single Specialty CurrentSince Mar 23, 2020 Accepting new patients

Locations

555 N Nash St
El Segundo, CA 90245
Phone (310) 535-4436

1084 N El Camino Real
#B351
Encinitas, CA 92024

440 Foothill Blvd
La Canada Flintridge, CA 91011
Phone (818) 369-7620

4515 Ocean View Blvd
Ste 350
La Canada Flt, CA 91011
Phone (818) 369-7620

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1396370177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19217 CANTARA ST",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913351115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 OCEAN VIEW BLVD STE 350",
            "city": "LA CANADA",
            "state": "CA",
            "postal_code": "910111409",
            "telephone_number": "818-369-7620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLESTEROS",
        "first_name": "BRETT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Canada, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.