NPIMap

Organization Active NPI

Anaheim Physical Therapy and Aquatic Rehab

Doing business as Magnolia Physical Therapy

  • Clinic/Center
  • Anaheim, CA
National Provider Identifier
1710934666
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
BUS2003-01454 Issued in CA
Legal business name
ANAHEIM PHYSICAL THERAPY AND AQUATIC REHAB
Doing business as
Magnolia Physical Therapy
Practice address
1189 N Euclid St
Anaheim, CA 92801-1938
Phone
(714) 808-0008
Fax
(714) 808-0168
NPI assigned
May 27, 2006
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mrs. Carol M. Fracalosy, PT
Title
Owner
Phone
(714) 808-0008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X BUS2003-01454 CA Primary

Addresses

Primary practice location

1189 N Euclid St
Anaheim, CA 92801-1938

Mailing address

1189 N Euclid St
Anaheim, CA 92801-1938
Phone (714) 808-0008

Other identifiers 1

IdentifierTypeStateIssuer
GPT001610MedicaidCA

Other names 1

  • Magnolia Physical Therapy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Anaheim Physical Therapy and Aquatic Rehab2 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

1189 N Euclid St
Anaheim, CA 92801
Phone (714) 808-0008

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1710934666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1189 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011938",
            "telephone_number": "714-808-0008",
            "fax_number": "714-808-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1189 N EUCLID ST",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928011938",
            "telephone_number": "714-808-0008",
            "fax_number": "714-808-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANAHEIM PHYSICAL THERAPY AND AQUATIC REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "FRACALOSY",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-808-0008",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "BUS2003-01454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT001610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.