Spectrum Orthopedic Sport Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPECTRUM ORTHOPEDIC SPORT THERAPY

Practice address

1140 Laurel St Ste D
San Carlos, CA 94070-5054

Phone

(650) 654-1223

Fax

(650) 654-1205

NPI assigned

Nov 6, 2007

Last updated

Jul 26, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth William Burns, PT CSCSNPI 1477524221

Title

Physical Therapist Owner

Phone

(650) 654-1223

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

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.

• Rose Shu-May Chao-Burns, P.T.

  • Physical Therapist
  • San Carlos, CA
  • NPI 1215055447
  Medicare reassignment
• Kenneth W Burns, PT, CSCS

  • Orthopedic Physical Therapist
  • San Carlos, CA
  • NPI 1477524221
  NPD (past) Authorized official
• Leila Chaychi, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • San Carlos, CA
  • NPI 1558535203
  NPD
• Grace S Kim, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • San Carlos, CA
  • NPI 1083634323
  NPD
• Katherine Teresa Kennedy, D.P.T.

  • Physical Therapist
  • San Carlos, CA
  • NPI 1639382393
  NPD (past)

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1417137530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 LAUREL ST STE D",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940705054",
            "telephone_number": "650-654-1223",
            "fax_number": "650-654-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 LAUREL ST STE D",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940705054",
            "telephone_number": "650-654-1223",
            "fax_number": "650-654-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM ORTHOPEDIC SPORT THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST OWNER",
        "authorized_official_telephone_number": "650-654-1223",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soniqe LLC (101 Mobility)
• Chanel Sotelo, LCSW
• Emily Spadafora, MFTI
• Jaylen Z Spann
• Erica L Spartos, LMFT
• Steven Andrew Sprague, DC
• Samantha Steele, DPT
• Alexis Christine Stephano, AMFT
• Stephen R. John, DDS, Apc
• Yair Sterental

• Physical Therapist in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.