Individual provider Active NPI

Paul Michael Lally, PT, DPT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1508356130
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT299985 Issued in CA
Practice address
7525 Metropolitan Dr Ste 306
San Diego, CA 92108-4404
Phone
(844) 316-7979
Fax
(866) 813-1235
NPI assigned
May 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT013485 GA
Physical Therapist 225100000X 11752 TN
Physical Therapist 225100000X PT299985 CA Primary

Addresses

Primary practice location

7525 Metropolitan Dr Ste 306
San Diego, CA 92108-4404

Mailing address

7525 Metropolitan Dr Ste 306
San Diego, CA 92108-4404
Phone (844) 316-7979

Other identifiers 1

IdentifierTypeStateIssuer
299985OtherCAPT LICENSE

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
11752TNMDGeneral Practice Dentistry
PT299985CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Spinezone Medical Fitness, Inc. Physical Therapist PastSince Dec 6, 2021 Accepting new patients
Pediatric Orthopedic Associates Past Accepting new patients
Livara Health Medical Group NJ, PC Physical Therapist Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1508356130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7525 METROPOLITAN DR STE 306",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084404",
            "telephone_number": "844-316-7979",
            "fax_number": "866-813-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7525 METROPOLITAN DR STE 306",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921084404",
            "telephone_number": "844-316-7979",
            "fax_number": "866-813-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLY",
        "first_name": "PAUL",
        "middle_name": "MICHAEL",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-18",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013485",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "11752",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT299985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "299985",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; 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.