NPIMap

Organization Active NPI

Providence Physical Therapy, Inc

  • Physical Therapist
  • Ontario, CA
National Provider Identifier
1417175175
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 15402 Issued in CA
Legal business name
PROVIDENCE PHYSICAL THERAPY, INC
Practice address
3550 E Philadelphia St
Suite # 155
Ontario, CA 91761-2962
Phone
(909) 773-0022
Fax
(866) 672-8222
NPI assigned
Apr 20, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Peter M Aziz, RPTNPI 1760601793
Title
Director of Therapy
Phone
(909) 773-0022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT 15402 CA Primary

Addresses

Primary practice location

3550 E Philadelphia St
Suite # 155
Ontario, CA 91761-2962

Mailing address

3550 E Philadelphia St
Suite # 155
Ontario, CA 91761-2962
Phone (909) 773-0022

Other identifiers 1

IdentifierTypeStateIssuer
BL#67598OtherCABUSINESS LICENSE NUMBER

National Provider Directory

National Provider Directory

Locations

3550 E Philadelphia St
Ste 155
Ontario, CA 91761
Phone (909) 773-0022

Practitioners & affiliated clinicians

Practitioners 1

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": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417175175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 E PHILADELPHIA ST",
            "address_2": "SUITE # 155",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917612962",
            "telephone_number": "909-773-0022",
            "fax_number": "866-672-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 E PHILADELPHIA ST",
            "address_2": "SUITE # 155",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917612962",
            "telephone_number": "909-773-0022",
            "fax_number": "866-672-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AZIZ",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF THERAPY",
        "authorized_official_telephone_number": "909-773-0022",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 15402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE NUMBER",
            "identifier": "BL#67598",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.