Individual provider Active NPI

Michael J Landoch, PT

  • Physical Therapist
  • Los Angeles, CA
National Provider Identifier
1578643573
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT12441 Issued in CA
Practice address
6214 W Manchester Ave
Los Angeles, CA 90045-3801
Phone
(310) 348-8464
Fax
(310) 348-8470
NPI assigned
Oct 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT12441 CA Primary

Addresses

Primary practice location

6214 W Manchester Ave
Los Angeles, CA 90045-3801

Mailing address

6214 W Manchester Ave
Los Angeles, CA 90045-3801
Phone (310) 348-8464

Other identifiers 1

IdentifierTypeStateIssuer
OPT124410OtherCABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120327000040 CA Practitioner - Physical Therapist in Private Practice 3476536400 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Care, IncGroup PAC ID 5890778823, 2 clinicians

Practice addresses (Care Compare)

6214 W Manchester Ave
Los Angeles, CA 90045-3801
Phone (310) 348-8464

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT12441CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Therapy Care, Inc Physical Therapist CurrentSince Jan 1, 1994 Accepting new patients

Locations

6214 W Manchester Ave
Los Angeles, CA 90045
Phone (310) 348-8464

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578643573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6214 W MANCHESTER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453801",
            "telephone_number": "310-348-8464",
            "fax_number": "310-348-8470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6214 W MANCHESTER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453801",
            "telephone_number": "310-348-8464",
            "fax_number": "310-348-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDOCH",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT12441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "OPT124410",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.