Genesis Sports Performance Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

GENESIS SPORTS PERFORMANCE INC

Practice address

22600 Lambert St Ste 1204F
Lake Forest, CA 92630-1623

Phone

(949) 838-6686

NPI assigned

Jul 22, 2019

Last updated

Jul 22, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Campbell, PTNPI 1982781266

Title

Owner/Physical Therapist

Phone

(949) 838-6686

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Marie Campbell, PT

  • Physical Therapist
  • Lake Forest, CA
  • NPI 1982781266
  Authorized official Same address or phone

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563753600000",
    "number": "1679126320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22600 LAMBERT ST STE 1204F",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301623",
            "telephone_number": "949-838-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22600 LAMBERT ST STE 1204F",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926301623",
            "telephone_number": "949-838-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS SPORTS PERFORMANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2019-07-22",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "949-838-6686",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garden Grove Pathology Medical Group PC
• Garfield Beach CVS LLC (CVS Pharmacy 09587)
• Megan Elisabeth Gavitt
• Julia Gearhart
• Jasmine Gemoya
• Genomic Testing Cooperative Lca
• Benjamin Philip Gerami, PT, DPT
• Azita Ghaderifard, FNP
• Timothy Ghalbi, D.C.
• Abbas Ghodoumipour

• Physical Therapist in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; 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.