NPIMap

Organization Active NPI

Davis and Derosa Physical Therapy, Inc

  • Physical Therapist
  • El Segundo, CA
National Provider Identifier
1558414102
Registry record updated Jun 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT25036 Issued in CA
Legal business name
DAVIS AND DEROSA PHYSICAL THERAPY, INC
Practice address
325 Main St
El Segundo, CA 90245-3814
Phone
(310) 648-3167
Fax
(310) 648-3175
NPI assigned
Jan 18, 2007
Last updated
Jun 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2014

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

Authorized official

Name
Troy Davis, RPTNPI 1760535314
Title
Owner
Phone
(310) 648-3167

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT25036 CA Primary

Addresses

Primary practice location

325 Main St
El Segundo, CA 90245-3814

Mailing address

325 Main St
El Segundo, CA 90245-3814
Phone (310) 648-3167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050720001074 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7113954264 Receives reassigned benefits from 22 practitioners
Practice locations: El Segundo, CA; Hermosa Beach, CA

National Provider Directory

National Provider Directory

Locations

325 Main St
El Segundo, CA 90245
Phone (310) 648-3167

327 Richmond St
El Segundo, CA 90245
Phone (310) 648-3167

2615 Pacific Coast Hwy
Ste 120
Hermosa Beach, CA 90254
Phone (310) 933-3690

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1558414102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-648-3167",
            "fax_number": "310-648-3175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 MAIN ST",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902453814",
            "telephone_number": "310-648-3167",
            "fax_number": "310-648-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS AND DEROSA PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-648-3167",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT25036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.