NPIMap

Organization Active NPI

Evolve Integrated Wellness and Physical Therapy PC

  • Physical Therapist
  • Rancho Santa Margarita, CA
National Provider Identifier
1811264872
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
22362 Issued in CA
Legal business name
EVOLVE INTEGRATED WELLNESS AND PHYSICAL THERAPY PC
Practice address
30085 Comercio
Rancho Santa Margarita, CA 92688-2106
Phone
(818) 822-1600
NPI assigned
Nov 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

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

Authorized official

Name
Prof. Dawn-Marie Ickes, M.P.T.
Title
Owner
Phone
(818) 822-1600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 22362 CA Primary

Addresses

Primary practice location

30085 Comercio
Rancho Santa Margarita, CA 92688-2106

Mailing address

30085 Comercio
Rancho Santa Margarita, CA 92688-2106
Phone (818) 822-1600

National Provider Directory

National Provider Directory

Locations

30085 Comercio
Rcho Sta Marg, CA 92688
Phone (949) 766-8535

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1321574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321574400000",
    "number": "1811264872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30085 COMERCIO",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882106",
            "telephone_number": "818-822-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30085 COMERCIO",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882106",
            "telephone_number": "818-822-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE INTEGRATED WELLNESS AND PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-18",
        "last_updated": "2011-11-18",
        "status": "A",
        "authorized_official_last_name": "ICKES",
        "authorized_official_first_name": "DAWN-MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-822-1600",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "22362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.