Individual provider Active NPI

Alex Vondachenhausen, P.T.

  • Physical Therapist
  • Redding, CA
National Provider Identifier
1659390359
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT11358 Issued in CA
Practice address
320 Hartnell Ave
Redding, CA 96002-1846
Phone
(530) 226-9242
Fax
(530) 226-9070
NPI assigned
Jul 19, 2006
Last updated
Sep 20, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 20, 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 PT11358 CA Primary

Addresses

Primary practice location

320 Hartnell Ave
Redding, CA 96002-1846

Mailing address

2520 Goodwater Ave
Suite a
Redding, CA 96002-1514
Phone (530) 224-3322

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ23129ZOtherMEDICARE GROUP

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT11358CAMDPhysical Therapist
11358CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Elevate Physical Therapy Inc Physical Therapist CurrentSince Aug 23, 2020 Accepting new patients
Amundson Physical Therapy Physical Therapist Past Accepting new patients

Locations

1920 Barney Rd
Anderson, CA 96007
Phone (530) 365-2142

Organizations & group practices 2

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190246400000",
    "number": "1659390359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 GOODWATER AVE",
            "address_2": "SUITE A",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960021514",
            "telephone_number": "530-224-3322",
            "fax_number": "530-224-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 HARTNELL AVE",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960021846",
            "telephone_number": "530-226-9242",
            "fax_number": "530-226-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VONDACHENHAUSEN",
        "first_name": "ALEX",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT11358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "ZZZ23129Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.