NPIMap

Organization Active NPI

Innovative Physical Therapy Inc

  • Orthopedic Physical Therapist
  • San Diego, CA
National Provider Identifier
1821047580
Registry record updated Mar 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
PT12294 Issued in CA
Legal business name
INNOVATIVE PHYSICAL THERAPY INC
Practice address
5030 Camino de la Siesta
Suite 220
San Diego, CA 92108-3116
Phone
(619) 260-0750
Fax
(619) 260-0201
NPI assigned
May 9, 2006
Last updated
Mar 6, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2014

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

Authorized official

Name
Ms. Marilyn S Johnson, P.T.NPI 1073557708
Title
President
Phone
(619) 260-0750

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
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X PT12294 CA Primary

Addresses

Primary practice location

5030 Camino de la Siesta
Suite 220
San Diego, CA 92108-3116

Mailing address

5030 Camino de la Siesta
Suite 220
San Diego, CA 92108-3116
Phone (619) 260-0750

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060724000345 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0042223703 Receives reassigned benefits from 7 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

7855 Fay Ave
Ste 290
La Jolla, CA 92037
Phone (619) 260-0750

5030 Camino de la Siesta
Ste 220
San Diego, CA 92108
Phone (619) 260-0750

5505 Friars Rd
San Diego, CA 92110
Phone (619) 260-0750

5920 Friars Rd
Ste 102
San Diego, CA 92108
Phone (619) 260-0750

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394064000000",
    "number": "1821047580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 CAMINO DE LA SIESTA",
            "address_2": "SUITE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083116",
            "telephone_number": "619-260-0750",
            "fax_number": "619-260-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 CAMINO DE LA SIESTA",
            "address_2": "SUITE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083116",
            "telephone_number": "619-260-0750",
            "fax_number": "619-260-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2014-03-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-260-0750",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT12294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; 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.