NPIMap

Organization Active NPI

Dacosta Collymore

Doing business as Pacific Rehabilitation

  • Physical Therapist
  • Culver City, CA
National Provider Identifier
1609058445
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
20709 Issued in CA
Legal business name
DACOSTA COLLYMORE
Doing business as
Pacific Rehabilitation
Practice address
5000 Overland Ave
#4
Culver City, CA 90230
Phone
(310) 836-7650
Fax
(310) 836-7651
NPI assigned
Dec 4, 2007
Last updated
Jun 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Authorized official

Name
Dacosta Alonzo Collymore, RPTNPI 1568497659
Title
Ceo Owner
Phone
(310) 836-7650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 20709 CA Primary

Addresses

Primary practice location

5000 Overland Ave
#4
Culver City, CA 90230

Mailing address

5000 Overland Ave
#4
Culver City, CA 90230
Phone (310) 836-7650

Other names 1

  • Pacific Rehabilitation Doing business as

National Provider Directory

National Provider Directory

Locations

5000 Overland Ave
#4
Culver City, CA 90230
Phone (310) 836-7650

5000 Overland Ave
Ste 104
Culver City, CA 90230
Phone (213) 819-4783

5000 Overland Ave
Ste 4
Culver City, CA 90230
Phone (213) 819-4783

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1609058445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 OVERLAND AVE",
            "address_2": "#4",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "90230",
            "telephone_number": "310-836-7650",
            "fax_number": "310-836-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 OVERLAND AVE",
            "address_2": "#4",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "90230",
            "telephone_number": "310-836-7650",
            "fax_number": "310-836-7651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DACOSTA COLLYMORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "COLLYMORE",
        "authorized_official_first_name": "DACOSTA",
        "authorized_official_middle_name": "ALONZO",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "310-836-7650",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "20709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.