Sports Industrial Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT8535 Issued in CA

Legal business name

SPORTS INDUSTRIAL PHYSICAL THERAPY

Practice address

10427 San Sevaine Way
Ste K
Mira Loma, CA 91752-1199

Phone

(951) 360-8333

NPI assigned

Jul 30, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lawrence William Carter, P.T.

Title

Owner

Phone

(951) 360-8333

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Douglas Angus Pollock, PT

  • Physical Therapist
  • Mira Loma, CA
  • NPI 1023202538
  NPD (past)

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629083480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10427 SAN SEVAINE WAY",
            "address_2": "STE K",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917521199",
            "telephone_number": "951-360-8333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10427 SAN SEVAINE WAY",
            "address_2": "STE K",
            "city": "MIRA LOMA",
            "state": "CA",
            "postal_code": "917521199",
            "telephone_number": "951-360-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS INDUSTRIAL PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-360-8333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT8535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roylene Debra Scott, D.C.
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• Kristie Anh Vo, O.D
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• Amy J Walport, O.D.
• Jessie Marie Welch

• Physical Therapist in Mira Loma, CA
• Providers in Mira Loma, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.