NPIMap

Organization Active NPI

Physical Edge, Inc.

  • Physical Therapist
  • Davis, CA
National Provider Identifier
1770675639
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22276 Issued in CA
Legal business name
PHYSICAL EDGE, INC.
Practice address
1460 Drew Avenue, Suite 200
Davis, CA 95618
Phone
(530) 753-9011
NPI assigned
Sep 29, 2006
Last updated
Mar 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Authorized official

Name
Mathew Moore, MPTNPI 1295825644
Title
Owner
Phone
(530) 753-9011

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 8

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6526 CA
Physical Therapist 225100000X 30188 CA
Physical Therapist 225100000X 32377 CA
Physical Therapist 225100000X 27732 CA
Physical Therapist 225100000X 22276 CA Primary
Pediatric Physical Therapist 2251P0200X PT 16894 CA
Hand Occupational Therapist 225XH1200X 1528 CA
Pediatric Occupational Therapist 225XP0200X OT 8402 CA

Addresses

Primary practice location

1460 Drew Avenue, Suite 200
Davis, CA 95618

Mailing address

1460 Drew Avenue, Suite 200
Davis, CA 95618

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041109001110 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7214990399 Receives reassigned benefits from 11 practitioners
Practice locations: Davis, CA

National Provider Directory

National Provider Directory
Tax ID family
Physical Edge Inc2 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1770675639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 DREW AVENUE, SUITE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 DREW AVENUE, SUITE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "95618",
            "telephone_number": "530-753-9011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL EDGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-753-9011",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "6526",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "30188",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "32377",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "27732",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "22276",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT 16894",
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "CA",
            "license": "1528",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "OT 8402",
            "primary": false
        }
    ],
    "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 Mar 13, 2009; 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.