NPIMap

Organization Active NPI

Montclair Physical Therapy, Inc.

Doing business as Active Method Physical Therapy

  • Physical Therapist
  • Oakland, CA
National Provider Identifier
1699791897
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT13625 Issued in CA
Legal business name
MONTCLAIR PHYSICAL THERAPY, INC.
Doing business as
Active Method Physical Therapy
Practice address
473 34TH St
Oakland, CA 94609-2815
Phone
(510) 339-2116
Fax
(510) 339-0647
NPI assigned
Jul 14, 2006
Last updated
Aug 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

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

Authorized official

Name
Siclalix Jimenez
Title
Office Manager
Phone
(510) 339-2116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT13625 CA Primary

Addresses

Primary practice location

473 34TH St
Oakland, CA 94609-2815

Mailing address

473 34TH St
Oakland, CA 94609-2815
Phone (510) 339-2116

Other practice location 1

3530 Fruitvale Ave
Oakland, CA 94602-2327
Phone (510) 339-2116

Other practice location 2

6116 Medau Pl
Oakland, CA 94611-2809
Phone (510) 339-2116 ext. 2

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ05096ZOtherCABLUE SHIELD CA GROUP NUMB

Other names 1

  • Active Method Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150603001135 CA Part B Supplier - Clinic/Group Practice 6406177450 Receives reassigned benefits from 3 practitioners
Practice locations: Oakland, CA

National Provider Directory

National Provider Directory

Locations

3530 Fruitvale Ave
Oakland, CA 94602
Phone (510) 333-1527

6116 Medau Pl
Oakland, CA 94611
Phone (510) 256-5811

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1699791897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-339-2116",
            "fax_number": "510-339-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-339-2116",
            "fax_number": "510-339-0647"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3530 Fruitvale Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946022327",
            "country_code": "US",
            "telephone_number": "510-339-2116",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6116 Medau Pl",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946112809",
            "country_code": "US",
            "telephone_number": "510-339-2116 x2",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MONTCLAIR PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "SICLALIX",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "510-339-2116"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT13625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA GROUP NUMB",
            "identifier": "ZZZ05096Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Active Method Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.