Individual provider Active NPI

Lala Keshishian

  • Physical Therapist
  • Rancho Cucamonga, CA
National Provider Identifier
1780352443
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
300825 Issued in CA
Practice address
10470 Foothill Blvd Ste 101
Rancho Cucamonga, CA 91730-3754
Phone
(909) 948-0411
Fax
(909) 948-0511
NPI assigned
Aug 30, 2021
Last updated
Jul 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 300825 CA Primary

Addresses

Primary practice location

10470 Foothill Blvd Ste 101
Rancho Cucamonga, CA 91730-3754

Mailing address

1845 Business Center Dr Ste 127
San Bernardino, CA 92408-3434
Phone (818) 424-6464

Other practice location 1

500 N Central Ave Ste 850
Glendale, CA 91203-3354
Phone (818) 549-9764

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220315001747 CA Practitioner - Physical Therapist in Private Practice 2365837127 Reassigns benefits to 1 organization
Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
United Therapy Network Incorporated Physical Therapist CurrentSince Jan 17, 2022 Accepting new patients
United Therapy Network Incorporated Physical Therapist CurrentSince Jan 17, 2022 Accepting new patients
United Therapy Network Incorporated Physical Therapist Current Accepting new patients

Locations

802 Magnolia Ave
Ste 107
Corona, CA 92879
Phone (951) 340-0070

500 N Central Ave
Ste 850
Glendale, CA 91203
Phone (818) 549-9764

1902 Royalty Dr
Ste 220
Pomona, CA 91767
Phone (909) 570-3108

10470 Foothill Blvd
Ste 101
Rancho Cucamonga, CA 91730
Phone (909) 948-0411

1845 Business Center Dr
Ste 127
Sn Bernrdno, CA 92408
Phone (909) 890-9030

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1780352443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 BUSINESS CENTER DR STE 127",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083434",
            "telephone_number": "818-424-6464",
            "fax_number": "909-890-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10470 FOOTHILL BLVD STE 101",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303754",
            "telephone_number": "909-948-0411",
            "fax_number": "909-948-0511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 N Central Ave Ste 850",
            "address_purpose": "LOCATION",
            "city": "Glendale",
            "state": "CA",
            "postal_code": "912033354",
            "country_code": "US",
            "telephone_number": "818-549-9764",
            "fax_number": "818-549-9767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KESHISHIAN",
        "first_name": "LALA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "300825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.