NPIMap

Organization Active NPI

Manhattan Beach Pacific Physical Therapy Inc

Doing business as Pacific Physical Therapy

  • Physical Therapist
  • El Segundo, CA
National Provider Identifier
1396799458
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MANHATTAN BEACH PACIFIC PHYSICAL THERAPY INC
Doing business as
Pacific Physical Therapy
Practice address
327 Main St
El Segundo, CA 90245-3814
Phone
(310) 725-8505
Fax
(310) 648-3175
NPI assigned
May 20, 2006
Last updated
Jun 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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

Authorized official

Name
Mr. Christopher P Derosa, PTNPI 1003056797
Title
Ceo
Phone
(310) 648-3167

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X CA Primary

Addresses

Primary practice location

327 Main St
El Segundo, CA 90245-3814

Mailing address

327 Main St
El Segundo, CA 90245-3814
Phone (310) 725-8505

Other names 1

  • Pacific Physical Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL http://www.pacificphysicaltherapy.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314001147 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4587619457 Receives reassigned benefits from 22 practitioners
Practice locations: El Segundo, CA; Hermosa Beach, CA

National Provider Directory

National Provider Directory

Locations

327 Main St
El Segundo, CA 90245
Phone (310) 322-9700

2615 Pacific Coast Hwy
Ste 125
Hermosa Beach, CA 90254
Phone (310) 798-6310

1330 Park View Ave
Ste 40
Manhattan Beach, CA 90266

1332 Park View Ave
Ste 103
Manhattan Beach, CA 90266
Phone (310) 796-1338

Practitioners & affiliated clinicians

Practitioners 39

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 39

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1396799458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-725-8505",
            "fax_number": "310-648-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-725-8505",
            "fax_number": "310-648-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANHATTAN BEACH PACIFIC PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-648-3167",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "http://www.pacificphysicaltherapy.com",
            "affiliation": "N",
            "address_1": "327 Main St",
            "city": "El Segundo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902453814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Pacific Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.