Iconic Sports Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ICONIC SPORTS PHYSICAL THERAPY PC

Practice address

1317 W Foothill Blvd Ste 100
Upland, CA 91786-3676

Phone

(626) 826-5921

NPI assigned

Feb 25, 2026

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Banh, PT, DPTNPI 1639784457

Title

Ceo, Cfo, Secretary

Phone

(909) 671-1553

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Banh, DPT

  • Physical Therapist
  • Irvine, CA
  • NPI 1639784457
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1771977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1447104476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 W FOOTHILL BLVD STE 100",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863676",
            "telephone_number": "909-671-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W FOOTHILL BLVD STE 100",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863676",
            "telephone_number": "626-826-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONIC SPORTS PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-25",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "BANH",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO, CFO, SECRETARY",
        "authorized_official_telephone_number": "909-671-1553",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Upland, CA
• Providers in Upland, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; 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.