Sport Clinic Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18871 Issued in CA

Legal business name

SPORT CLINIC INC

Practice address

39180 Farwell Dr
Suite 101
Fremont, CA 94538-1052

Phone

(510) 438-0294

Fax

(510) 438-0468

NPI assigned

Jul 15, 2006

Last updated

Mar 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Darryl Lance Lopez, PTNPI 1831117266

Title

Vice President Sercetary

Phone

(510) 438-0294

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 6

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.

• Darryl Lance Lopez, PT

  • Physical Therapist
  • Fremont, CA
  • NPI 1831117266
  Medicare reassignment NPD Authorized official
• Trevor Dimich

  • Physical Therapist
  • Fremont, CA
  • NPI 1093460701
  Medicare reassignment NPD
• Jason Lagmay Prestosa, PT, DPT

  • Orthopedic Physical Therapist
  • San Ramon, CA
  • NPI 1568837532
  Medicare reassignment NPD
• Michelle K Nomura, MPT

  • Orthopedic Physical Therapist
  • Fremont, CA
  • NPI 1801951652
  NPD
• Pono Victor Aiona, D.C

  • Sports Physician Chiropractor
  • Fremont, CA
  • NPI 1114948023
  NPD (past)
• Mei-Kuen Grace Chung, OT

  • Occupational Therapist
  • Hayward, CA
  • NPI 1073828299
  NPD (past)

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1497771901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39180 FARWELL DR",
            "address_2": "SUITE 101",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381052",
            "telephone_number": "510-438-0294",
            "fax_number": "510-438-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39180 FARWELL DR",
            "address_2": "SUITE 101",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381052",
            "telephone_number": "510-438-0294",
            "fax_number": "510-438-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_middle_name": "LANCE",
        "authorized_official_title_or_position": "VICE PRESIDENT SERCETARY",
        "authorized_official_telephone_number": "510-438-0294",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT18871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larisa Southerland, AMFT
• Robert Sentell Spears, M.D.
• Valerie Spier, RD
• Thomas Gerard Spillner, D.D.S.
• Giancarlo Sponzilli
• Sports Imaging, LLC
• Julie Marie Sprague-McRae, PNP
• Blake Spurlock
• Nicholas Squires, MD
• Kirandeep Kaur Sran, FNP

• Physical Therapist in Fremont, CA
• Providers in Fremont, 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 18, 2011; 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.