Individual provider Active NPI

John Nisperos

  • Physical Therapy Assistant
  • Stockton, CA
National Provider Identifier
1629987748
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
9416 Issued in CA
Practice address
6940 Pacific Ave
Stockton, CA 95207-2602
Phone
(209) 477-4817
NPI assigned
Sep 3, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 9416 CA Primary

Addresses

Primary practice location

6940 Pacific Ave
Stockton, CA 95207-2602

Mailing address

4705 Dahlia Dr
Stockton, CA 95212-2117
Phone (805) 206-0596

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1788393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788393600000",
    "number": "1629987748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4705 DAHLIA DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952122117",
            "telephone_number": "805-206-0596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6940 PACIFIC AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952072602",
            "telephone_number": "209-477-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISPEROS",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-09-03",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "9416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.