Individual provider Active NPI

Laura Fahey, PT, DPT

  • Physical Therapist
  • El Monte, CA
National Provider Identifier
1669421087
Registry record updated Jun 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
34688 Issued in CA
Practice address
3111 Santa Anita Ave
El Monte, CA 91733-1357
Phone
(626) 443-0218
NPI assigned
May 10, 2006
Last updated
Jun 10, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2019

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 34688 CA Primary

Addresses

Primary practice location

3111 Santa Anita Ave
El Monte, CA 91733-1357

Mailing address

8410 Derfer Dr
Rancho Cucamonga, CA 91701-5462
Phone (315) 345-8741

Other practice location 1

68 Willow Rd
Menlo Park, CA 94025-3653
Phone (866) 839-6979

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090409000236 CA Practitioner - Physical Therapist in Private Practice 9234214347 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34688CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Center for Bone and Joint Disorders CurrentSince Jan 15, 2024 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Jun 19, 2019 Accepting new patients
PTP, Inc Physical Therapist Past Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 409-4167

68 Willow Rd
Menlo Park, CA 94025
Phone (650) 691-8630

8045 Archibald Ave
Ste 100
Rch Cucamonga, CA 91730
Phone (909) 920-0876

400 N Mountain Ave
Ste 310
Upland, CA 91786
Phone (909) 920-0876

Organizations & group practices 3

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": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560124800000",
    "number": "1669421087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8410 DERFER DR",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917015462",
            "telephone_number": "315-345-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 SANTA ANITA AVE",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917331357",
            "telephone_number": "626-443-0218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "68 Willow Rd",
            "address_purpose": "LOCATION",
            "city": "Menlo Park",
            "state": "CA",
            "postal_code": "940253653",
            "country_code": "US",
            "telephone_number": "866-839-6979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAHEY",
        "first_name": "LAURA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2019-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "34688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Monte, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.