Active NPI
Stephen Grosserode, DPT
- Orthopedic Physical Therapist
- Los Angeles, CA
National Provider Identifier
1659681997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 36953
- Practice address
- 488 S San Vicente Blvd
Los Angeles, CA 90048-4107 - Phone
- (323) 655-9055
- NPI assigned
- Oct 20, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 36953 | CA | Primary |
Addresses
Primary practice location
488 S San Vicente Blvd
Los Angeles, CA 90048-4107
Mailing address
808 4TH St Apt 212
Santa Monica, CA 90403-1229
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
| License | State | Type | Specialty |
|---|---|---|---|
| 36953 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363651200000",
"number": "1659681997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 4TH ST APT 212",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904031229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "488 S SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900484107",
"telephone_number": "323-655-9055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSERODE",
"first_name": "STEPHEN",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-10-20",
"last_updated": "2013-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "CA",
"license": "36953",
"primary": true
}
],
"identifiers": [],
"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 Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.