NPIMap

Organization Active NPI

South Bay Sports Medicine Physical Therapy Inc.

  • Physical Therapist
  • Torrance, CA
National Provider Identifier
1780770214
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 12037 Issued in CA
Legal business name
SOUTH BAY SPORTS MEDICINE PHYSICAL THERAPY INC.
Practice address
3878 West Carson Street
Suite 100
Torrance, CA 90503
Phone
(310) 543-4655
Fax
(310) 543-1743
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael N Fischvogt, P.T.NPI 1831284231
Title
Corporation President/Owner
Phone
(310) 543-4655

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT 12037 CA Primary

Addresses

Primary practice location

3878 West Carson Street
Suite 100
Torrance, CA 90503

Mailing address

3878 West Carson Street
Suite 100
Torrance, CA 90503
Phone (310) 543-4655

Other names 1

  • Denmond Corporation Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050901000337 CA Part B Supplier - Clinic/Group Practice 0244262087 Receives reassigned benefits from 7 practitioners
Practice locations: Torrance, CA

National Provider Directory

National Provider Directory

Locations

3878 W Carson St
Ste 100
Torrance, CA 90503
Phone (310) 543-4655

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780770214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3878 WEST CARSON STREET",
            "address_2": "SUITE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "90503",
            "telephone_number": "310-543-4655",
            "fax_number": "310-543-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3878 WEST CARSON STREET",
            "address_2": "SUITE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "90503",
            "telephone_number": "310-543-4655",
            "fax_number": "310-543-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY SPORTS MEDICINE PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FISCHVOGT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CORPORATION PRESIDENT/OWNER",
        "authorized_official_telephone_number": "310-543-4655",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 12037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Denmond Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Torrance, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.