Individual provider Active NPI

Caitlyn Croghan, PTA

  • Physical Therapy Assistant
  • Monterey, CA
National Provider Identifier
1407325673
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA49621 Issued in CA
Practice address
1575 Skyline Dr
Monterey, CA 93940-4110
Phone
(831) 373-2731
NPI assigned
Nov 17, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X
Physical Therapy Assistant 225200000X PTA49621 CA Primary

Addresses

Primary practice location

1575 Skyline Dr
Monterey, CA 93940-4110

Mailing address

24851 Evening Shadow CT
Moreno Valley, CA 92557-4207

Other practice location 1

24851 Evening Shadow Ct
Moreno Valley, CA 92557-4207
Phone (951) 214-9080

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
PTA49621CAMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1542412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1407325673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24851 EVENING SHADOW CT",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925574207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 SKYLINE DR",
            "city": "MONTEREY",
            "state": "CA",
            "postal_code": "939404110",
            "telephone_number": "831-373-2731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24851 Evening Shadow Ct",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925574207",
            "country_code": "US",
            "telephone_number": "951-214-9080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROGHAN",
        "first_name": "CAITLYN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-17",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "PTA49621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monterey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.