Active NPI
Bongsam Choi, P.T
- Physical Therapy Clinic/Center
- Gainesville, FL
National Provider Identifier
1669517488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- License
- PT8796
- Practice address
- 11504 NW 15TH LN
Gainesville, FL 32606-1400 - Phone
- (352) 332-0572
- NPI assigned
- Feb 20, 2007
- 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 |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | PT8796 | FL | Primary |
Addresses
Primary practice location
11504 NW 15TH LN
Gainesville, FL 32606-1400
Mailing address
11504 NW 15TH LN
Gainesville, FL 32606-1400
Phone (352) 332-0572
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 |
|---|---|---|---|
| PT8796 | FL | MD | Physical Therapy Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Outreach Inc | Physical Therapy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669517488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11504 NW 15TH LN",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326061400",
"telephone_number": "352-332-0572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11504 NW 15TH LN",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326061400",
"telephone_number": "352-332-0572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHOI",
"first_name": "BONGSAM",
"name_prefix": "Mr.",
"credential": "P.T",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "FL",
"license": "PT8796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.