Susan Mais-Requejo, D.P.T.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT18717 Issued in CA

Practice address

2819 Josie Ave
Long Beach, CA 90815-1515

Phone

(562) 743-3761

Fax

(596) 496-3628

NPI assigned

Jun 13, 2007

Last updated

Apr 30, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California State University Long BeachGroup PAC ID 9436466042, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• California State University Long Beach

  dba PT@TheBeach

  • Physical Therapist
  • Long Beach, CA
  • NPI 1861824518

  Orthopedic

  Medicare reassignment Care Compare group NPD
• John M. Somerndike Physical Therapy, PC

  dba Orange Coast Orthopedic and Sports Physical Therapy

  • Physical Therapy Clinic/Center
  • Orange, CA
  • NPI 1578861076

  Orthopedic

  Medicare reassignment NPD

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1730383506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2819 JOSIE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908151515",
            "telephone_number": "562-743-3761",
            "fax_number": "596-496-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 JOSIE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908151515",
            "telephone_number": "562-743-3761",
            "fax_number": "596-496-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIS-REQUEJO",
        "first_name": "SUSAN",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT18717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PT181717",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sean T Mai, DOCTOR OF PHARMACY
• Christiana Maiella, FNP
• Christa Maikisch
• Henry Maillefer, PHARM.D.
• Madelynn Alexandra Main, M.S. CCC-SLP
• Jill E. Maiten, NURSE PRACTITIONER
• Christine M. Maitland-Koeh, M.S.W.
• Michael Paul Majancsik, D.C.
• Majestic Medical Clinic, Inc.
• Katherine Ann Majewski, ACSW

• Orthopedic Physical Therapist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.