NPIMap

Organization Active NPI

Prorehab Physical Therapy and Sports Performance, Inc

  • Orthopedic Physical Therapist
  • Redding, CA
National Provider Identifier
1699257857
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
293605 Issued in CA
Legal business name
PROREHAB PHYSICAL THERAPY AND SPORTS PERFORMANCE, INC
Practice address
3673 Eureka Way
Redding, CA 96001
Phone
(530) 646-5205
NPI assigned
Sep 5, 2018
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Rachel Katharine Lange, DPTNPI 1538687769
Title
Owner
Phone
(530) 646-5205

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 293605 CA Primary

Addresses

Primary practice location

3673 Eureka Way
Redding, CA 96001

Mailing address

3772 Wolverine Dr.
Redding, CA 96001
Phone (530) 646-5205

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200407003160 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0446689798 Receives reassigned benefits from 3 practitioners
Practice locations: Redding, CA

National Provider Directory

National Provider Directory

Locations

3050 C St
Redding, CA 96002

3673 Eureka Way
Redding, CA 96001
Phone (530) 533-5030

6512 Westside Rd
Ste B
Redding, CA 96001
Phone (530) 244-0115

Practitioners & affiliated clinicians

Practitioners 8

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": "1536105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1699257857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3772 WOLVERINE DR.",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "96001",
            "telephone_number": "530-646-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3673 EUREKA WAY",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "96001",
            "telephone_number": "530-646-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROREHAB PHYSICAL THERAPY AND SPORTS PERFORMANCE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-05",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_middle_name": "KATHARINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-646-5205",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "293605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 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.