Active NPI
Mark Connell
- Physical Therapist
- La Quinta, CA
National Provider Identifier
1508309477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT292361
- Practice address
- 45280 Seeley Dr
La Quinta, CA 92253-6834 - Phone
- (760) 610-7200
- NPI assigned
- Nov 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT292361 | CA | Primary |
Addresses
Primary practice location
45280 Seeley Dr
La Quinta, CA 92253-6834
Mailing address
3111 W Dr MLK Blvd
#500
Tampa, FL 33607-6235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT292361 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1480291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480291200000",
"number": "1508309477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3111 W DR MLK BLVD",
"address_2": "#500",
"city": "TAMPA",
"state": "FL",
"postal_code": "336076235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "45280 SEELEY DR",
"city": "LA QUINTA",
"state": "CA",
"postal_code": "922536834",
"telephone_number": "760-610-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELL",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-28",
"last_updated": "2016-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT292361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Quinta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.