Individual provider Active NPI

Shelley Lynn Tworek, DPT

  • Physical Therapist
  • Victorville, CA
National Provider Identifier
1780695304
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
29935 Issued in CA
Practice address
17270 Bear Valley Rd
Ste E-105
Victorville, CA 92395-7751
Phone
(760) 955-6061
Fax
(760) 955-6062
NPI assigned
Aug 10, 2006
Last updated
Nov 17, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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 29935 CA Primary

Addresses

Primary practice location

17270 Bear Valley Rd
Ste E-105
Victorville, CA 92395-7751

Mailing address

24630 Washington Ave
Ste 200
Murrieta, CA 92562-6177
Phone (951) 696-9353

Other identifiers 1

IdentifierTypeStateIssuer
0PT299350OtherCABLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050210000334 CA Practitioner - Physical Therapist in Private Practice 5991756686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rancho Physical Therapy IncGroup PAC ID 2365346491, 29 clinicians

Practice addresses (Care Compare)

12402 Industrial Blvd
Suite B2
Victorville, CA 92395-5889
Phone (760) 955-6061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29935CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Rancho Physical Therapy, Inc. Physical Therapist CurrentSince Mar 12, 2007 Accepting new patients
Rancho Physical Therapy, Inc. Physical Therapist Past Accepting new patients

Locations

25150 Hancock Ave
Ste 100
Murrieta, CA 92562
Phone (951) 698-7720

24630 Washington Ave
Ste 200
Murrieta, CA 92562

11276 5th St
Ste 400
Rch Cucamonga, CA 91730
Phone (909) 481-0437

12402 Industrial Blvd
Ste B2
Victorville, CA 92395
Phone (760) 955-6061

Organizations & group practices 2

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": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226880000000",
    "number": "1780695304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24630 WASHINGTON AVE",
            "address_2": "STE 200",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626177",
            "telephone_number": "951-696-9353",
            "fax_number": "951-973-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17270 BEAR VALLEY RD",
            "address_2": "STE E-105",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957751",
            "telephone_number": "760-955-6061",
            "fax_number": "760-955-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TWOREK",
        "first_name": "SHELLEY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2008-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "29935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0PT299350",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

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