NPIMap

Organization Active NPI

Prosport Physical Therapy Professionals Inc

  • Physical Therapist
  • Rancho Palos Verdes, CA
National Provider Identifier
1487648341
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROSPORT PHYSICAL THERAPY PROFESSIONALS INC
Practice address
28924 S Western Ave
Suite 101
Rancho Palos Verdes, CA 90275-0885
Phone
(310) 548-0104
Fax
(310) 548-0559
NPI assigned
Sep 7, 2005
Organization subpart
Yes
Parent organization
PALOS VERDES REHABILITATION CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Authorized official

Name
Bobby Ismail
Title
President
Phone
(209) 353-1988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

28924 S Western Ave
Suite 101
Rancho Palos Verdes, CA 90275-0885

Mailing address

PO Box 14155
Orange, CA 92863-1555
Phone (714) 450-4999

Other names 3

  • Palos Verdes Physical Therapy Doing business as
  • ProSport Physical Therapy Palos Verdes Doing business as
  • Palos Verdes Rehabilitation Clinic Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200304001273 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0749510634 Receives reassigned benefits from 107 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Orange, CA; Torrance, CA; San Juan Capistrano, CA; San Clemente, CA; Rancho Santa Margarita, CA; Rancho Palos Verdes, CA; Mission Viejo, CA; Los Angeles, CA…

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Prosport Physical Therapy Professionals Inc6 organizations share this tax ID, including this one
Part of
Palos Verdes Rehabilita

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2777 Bristol St
Ste B
Costa Mesa, CA 92626
Phone (949) 250-1112

871 S Tustin St
Orange, CA 92866
Phone (714) 633-7227

28924 S Western Ave
Ste 101
Rch Palos Vrd, CA 90275
Phone (310) 548-0101

801 Via Suerte
Ste 103
San Clemente, CA 92673
Phone (949) 485-5567

Practitioners & affiliated clinicians

Practitioners 106

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

View all 106

NPI Registry JSON

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701820800000",
    "number": "1487648341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14155",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928631555",
            "telephone_number": "714-450-4999",
            "fax_number": "714-974-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28924 S WESTERN AVE",
            "address_2": "SUITE 101",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902750885",
            "telephone_number": "310-548-0104",
            "fax_number": "310-548-0559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPORT PHYSICAL THERAPY PROFESSIONALS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALOS VERDES REHABILITATION CLINIC INC",
        "enumeration_date": "2005-09-07",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-353-1988"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palos Verdes Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ProSport Physical Therapy Palos Verdes",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Palos Verdes Rehabilitation Clinic Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rancho Palos Verdes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.