NPIMap

Organization Active NPI

Clear Lake Physical Therapy Inc

  • Physical Therapist
  • Clearlake, CA
National Provider Identifier
1477502912
Registry record updated Dec 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT17230 Issued in CA
Legal business name
CLEAR LAKE PHYSICAL THERAPY INC
Practice address
14855 Olympic Dr
Clearlake, CA 95422-9522
Phone
(707) 994-7248
Fax
(707) 994-7248
NPI assigned
May 10, 2006
Last updated
Dec 7, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2009

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

Authorized official

Name
Lawrence Hosmer Hurst, PT
Title
Owner
Phone
(707) 263-1295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT17230 CA Primary

Addresses

Primary practice location

14855 Olympic Dr
Clearlake, CA 95422-9522

Mailing address

14855 Olympic Dr
PO Box 3288
Clearlake, CA 95422-9522
Phone (707) 994-7248

Other identifiers 1

IdentifierTypeStateIssuer
GPT001040MedicaidCA

National Provider Directory

National Provider Directory

Locations

14855 Olympic Dr
Clearlake, CA 95422
Phone (707) 994-7248

Practitioners & affiliated clinicians

Practitioners 8

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": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260144000000",
    "number": "1477502912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14855 OLYMPIC DR",
            "address_2": "PO BOX 3288",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229522",
            "telephone_number": "707-994-7248",
            "fax_number": "707-994-7248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14855 OLYMPIC DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229522",
            "telephone_number": "707-994-7248",
            "fax_number": "707-994-7248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR LAKE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2009-12-07",
        "status": "A",
        "authorized_official_last_name": "HURST",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "HOSMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-263-1295",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT17230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT001040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2009; 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.