NPIMap

Organization Active NPI

Physical Edge Specialty Services

  • Physical Therapist
  • Davis, CA
National Provider Identifier
1740894005
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL EDGE SPECIALTY SERVICES
Practice address
1460 Drew Ave Ste 200
Davis, CA 95618-4856
Phone
(530) 753-9011
Fax
(530) 753-9021
NPI assigned
Sep 3, 2020
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Marianne Moore
Title
Administrator
Phone
(530) 753-9011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1460 Drew Ave Ste 200
Davis, CA 95618-4856

Mailing address

1460 Drew Ave Ste 200
Davis, CA 95618-4856
Phone (530) 753-9011

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1740894005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "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": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL EDGE SPECIALTY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-753-9011"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Sep 3, 2020; 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.