Lisa Marie Hardimon, MPT

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

PT19902 Issued in CA

Practice address

2621 Manhattan Beach Blvd
Redondo Beach, CA 90278-1604

Phone

(310) 374-0477

Fax

(310) 374-1605

NPI assigned

Oct 15, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lisa Marie Vincent Former name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PhysioworksGroup PAC ID 4587670633, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Physioworks

  • Physical Therapist
  • Redondo Beach, CA
  • NPI 1447286067

  Sports

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1528310547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 MANHATTAN BEACH BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902781604",
            "telephone_number": "310-374-0477",
            "fax_number": "310-374-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 MANHATTAN BEACH BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902781604",
            "telephone_number": "310-374-0477",
            "fax_number": "310-374-1605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDIMON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "PT19902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT19902",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "VINCENT",
            "middle_name": "MARIE",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Hansack
• Jo-Ann Hansen, M.ED., MSW, ASW
• Michael Wayne Hansen, OD
• Megan Hanson
• Aurore Harboyan, PHARMD
• Eryn Harman
• Celynna I Harnetiaux, MA, LMFT
• Anita Lerner Harris, LCSW
• Rachel Harris, LMFT
• Shawnea Harris

• Sports Physical Therapist in Redondo Beach, CA
• Providers in Redondo Beach, CA by specialty
• Sports Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.