NPIMap

Organization Active NPI

Riviera Sports Physical Therapy Inc

  • Physical Therapist
  • Redondo Beach, CA
National Provider Identifier
1801929369
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT17407 Issued in CA
Legal business name
RIVIERA SPORTS PHYSICAL THERAPY INC
Practice address
1204 S Pacific Coast Hwy
Redondo Beach, CA 90277-4904
Phone
(310) 316-3577
Fax
(310) 316-3578
NPI assigned
Mar 13, 2007
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Authorized official

Name
Frank Croasdale, PT,DPTNPI 1528191087
Title
Owner/Physical Therapist
Phone
(310) 316-3577

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 PT17407 CA Primary

Addresses

Primary practice location

1204 S Pacific Coast Hwy
Redondo Beach, CA 90277-4904

Mailing address

318 Avenue I # 389
Redondo Beach, CA 90277-5601
Phone (310) 316-3577

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810001509 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8426020363 Receives reassigned benefits from 7 practitioners
Practice locations: Redondo Beach, CA

National Provider Directory

National Provider Directory

Locations

1204 S Pacific Coast Hwy
Redondo Beach, CA 90277
Phone (310) 316-3577

225 Avenue I
Ste 110
Redondo Beach, CA 90277
Phone (310) 316-3577

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1801929369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 AVENUE I # 389",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902775601",
            "telephone_number": "310-316-3577",
            "fax_number": "310-316-3578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 S PACIFIC COAST HWY",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902774904",
            "telephone_number": "310-316-3577",
            "fax_number": "310-316-3578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVIERA SPORTS PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "CROASDALE",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "310-316-3577",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT17407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.