NPIMap

Organization Active NPI

Rancho Physical Therapy, Inc.

Doing business as Rancho Physical Therapy

  • Physical Therapist
  • Lake Elsinore, CA
National Provider Identifier
1407824162
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
RANCHO PHYSICAL THERAPY, INC.
Doing business as
Rancho Physical Therapy
Practice address
31764 Casino Dr Ste 106a&B
Lake Elsinore, CA 92530-2312
Phone
(951) 471-3300
Fax
(951) 471-3301
NPI assigned
Mar 9, 2006
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Gabriela Litt
Title
Credentialing
Phone
(951) 696-9353

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X CA Primary
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

31764 Casino Dr Ste 106a&B
Lake Elsinore, CA 92530-2312

Mailing address

600 Central Ave Ste C
Lake Elsinore, CA 92530-2740
Phone (951) 696-9353

Other identifiers 3

IdentifierTypeStateIssuer
1407824162MedicaidCA
ZZZ60304ZOtherCABLUE SHIELD - PT
ZZZ05533ZOtherCABLUE SHIELD - OT

Other names 1

  • Rancho Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040127001225 CA Part B Supplier - Clinic/Group Practice 2365346491 Receives reassigned benefits from 40 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Murrieta, CA; Victorville, CA; Temecula, CA; Riverside, CA; Rancho Cucamonga, CA; Perris, CA; Moreno Valley, CA; Menifee, CA…

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory

Locations

31764 Casino Dr
Ste 106A
Lake Elsinore, CA 92530
Phone (951) 471-3300

600 Central Ave
Ste C
Lake Elsinore, CA 92530

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1407824162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 CENTRAL AVE STE C",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302740",
            "telephone_number": "951-696-9353",
            "fax_number": "951-973-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31764 CASINO DR STE 106A&B",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925302312",
            "telephone_number": "951-471-3300",
            "fax_number": "951-471-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANCHO PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "LITT",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "951-696-9353"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407824162",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD - PT",
            "identifier": "ZZZ60304Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD - OT",
            "identifier": "ZZZ05533Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rancho Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rancho Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 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.