NPIMap

Organization Active NPI

Physical Edge, Inc.

  • Physical Therapist
  • Davis, CA
National Provider Identifier
1689606469
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22276 Issued in CA
Legal business name
PHYSICAL EDGE, INC.
Practice address
1970 Lake Blvd Ste 4
Davis, CA 95616-5663
Phone
(530) 753-9011
Fax
(530) 753-9021
NPI assigned
Jul 6, 2006
Last updated
Mar 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Authorized official

Name
Mr. Mathew Moore, MPTNPI 1295825644
Title
Owner
Phone
(530) 753-9011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6526 CA
Physical Therapist 225100000X 30188 CA
Physical Therapist 225100000X 32377 CA
Physical Therapist 225100000X 27732 CA
Physical Therapist 225100000X 22276 CA Primary
Hand Occupational Therapist 225XH1200X 1528 CA

Addresses

Primary practice location

1970 Lake Blvd Ste 4
Davis, CA 95616-5663

Mailing address

1970 Lake Blvd Ste 4
Davis, CA 95616-5663
Phone (530) 753-9011

National Provider Directory

National Provider Directory
Tax ID family
Physical Edge Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1970 Lake Blvd
Ste 4
Davis, CA 95616
Phone (530) 753-9011

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1689606469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 LAKE BLVD STE 4",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165663",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 LAKE BLVD STE 4",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165663",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL EDGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-753-9011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "6526",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "30188",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "32377",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "27732",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "22276",
            "primary": true
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "CA",
            "license": "1528",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Davis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.