NPIMap

Organization Active NPI

Advanced Wellness Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • Yucaipa, CA
National Provider Identifier
1497173363
Registry record updated Mar 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT15801 Issued in CA
Legal business name
ADVANCED WELLNESS PHYSICAL THERAPY, PC
Practice address
34799 Fairport Way
Yucaipa, CA 92399-6819
Phone
(909) 553-3434
NPI assigned
Mar 28, 2014
Last updated
Mar 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2020

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

Authorized official

Name
Ms. Leanne Chavez, P.T.NPI 1346669835
Title
Owner/Ceo
Phone
(909) 553-3434

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 Therapy Clinic/Center 261QP2000X PT15801 CA Primary

Addresses

Primary practice location

34799 Fairport Way
Yucaipa, CA 92399-6819

Mailing address

34799 Fairport Way
Yucaipa, CA 92399-6819
Phone (909) 262-0928

Other practice location 1

34247 Yucaipa Blvd
Suite I
Yucaipa, CA 92399-6117
Phone (909) 553-3434

National Provider Directory

National Provider Directory

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": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585353600000",
    "number": "1497173363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34799 FAIRPORT WAY",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923996819",
            "telephone_number": "909-262-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34799 FAIRPORT WAY",
            "city": "YUCAIPA",
            "state": "CA",
            "postal_code": "923996819",
            "telephone_number": "909-553-3434"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34247 Yucaipa Blvd",
            "address_2": "Suite I",
            "address_purpose": "LOCATION",
            "city": "Yucaipa",
            "state": "CA",
            "postal_code": "923996117",
            "country_code": "US",
            "telephone_number": "909-553-3434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED WELLNESS PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2020-03-28",
        "certification_date": "2020-03-28",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "LEANNE",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "909-553-3434",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT15801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucaipa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.