NPIMap

Organization Active NPI

Prime Rehab Center Physical Therapy a Professional Corporation

  • Physical Therapist
  • Fontana, CA
National Provider Identifier
1669914396
Registry record updated Sep 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT35680 Issued in CA
Legal business name
PRIME REHAB CENTER PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Practice address
8545 Sierra Ave
Fontana, CA 92335-3868
Phone
(909) 365-3557
Fax
(909) 658-8987
NPI assigned
Nov 11, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2020

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

Authorized official

Name
Julia Cuevas Adame
Title
Office Manager
Phone
(909) 365-3557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT35680 CA Primary

Addresses

Primary practice location

8545 Sierra Ave
Fontana, CA 92335-3868

Mailing address

8545 Sierra Ave
Fontana, CA 92335-3868
Phone (909) 365-3557

Other practice location 1

527 N Palm Ave Ste 101
Ontario, CA 91762-3215
Phone (909) 983-3557

Other identifiers 1

IdentifierTypeStateIssuer
PT35680OtherCACALIFORNIA PHYSICAL THERAPY BOARD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161223000059 CA Part B Supplier - Clinic/Group Practice 0749561157 Receives reassigned benefits from 7 practitioners
Practice locations: Fontana, CA; Ontario, CA

National Provider Directory

National Provider Directory

Locations

8110 Mango Ave
Ste 107
Fontana, CA 92335
Phone (909) 365-3557

8545 Sierra Ave
Fontana, CA 92335
Phone (909) 365-3557

527 N Palm Ave
Ste 101
Ontario, CA 91762
Phone (909) 983-3557

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599696000000",
    "number": "1669914396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8545 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353868",
            "telephone_number": "909-365-3557",
            "fax_number": "909-658-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8545 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353868",
            "telephone_number": "909-365-3557",
            "fax_number": "909-658-8987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "527 N Palm Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "CA",
            "postal_code": "917623215",
            "country_code": "US",
            "telephone_number": "909-983-3557",
            "fax_number": "909-658-8985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIME REHAB CENTER PHYSICAL THERAPY A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-11",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A",
        "authorized_official_last_name": "ADAME",
        "authorized_official_first_name": "JULIA",
        "authorized_official_middle_name": "CUEVAS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-365-3557"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT35680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA PHYSICAL THERAPY BOARD",
            "identifier": "PT35680",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; 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.